Provider Demographics
NPI:1982048815
Name:WATSON, EDDIE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:L
Last Name:WATSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 CRESCENT OAK DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4564
Mailing Address - Country:US
Mailing Address - Phone:713-370-5247
Mailing Address - Fax:713-456-2744
Practice Address - Street 1:1435 CRESCENT OAK DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4564
Practice Address - Country:US
Practice Address - Phone:713-370-5247
Practice Address - Fax:713-456-2744
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker