Provider Demographics
NPI:1841322179
Name:WATSON, JAMES KEITH (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KEITH
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-0704
Practice Address - Street 1:3448 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2906
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY410842085R0202X
NC2023-035102085R0202X
OH350901372085R0202X
WV226932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000221899OtherUNISON
7842870OtherAETNA
WV3810008681Medicaid
WVP00413760OtherRR MEDICARE (WV)
KYP00766035OtherRR MEDICARE (KY)
WV001968311OtherMTN ST BCBS
WV550493376 00OtherWV WORKER'S COMPENSATION
KY7100005910Medicaid
OH2728909Medicaid
KY50016928OtherPASSPORT
KY0683127Medicare PIN
KY50016928OtherPASSPORT
I71271Medicare UPIN
WV3810008681Medicaid