Provider Demographics
NPI:1447669692
Name:WATSON, MICHAEL (SF-IDC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:SF-IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 COUNTY ROAD 717
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-6105
Mailing Address - Country:US
Mailing Address - Phone:334-447-8023
Mailing Address - Fax:
Practice Address - Street 1:1713 COUNTY ROAD 717
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-6105
Practice Address - Country:US
Practice Address - Phone:334-447-8023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman