MEDICARE: DR. STEPHEN W. WATSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	12907	SC

General Provider Information

NPI Number	:	1053386995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN W. WATSON M.D.

Provider Business Mailing Address
First Line	:	3 MEDICAL PARK RD STE 400
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6886
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 RICHLAND MEDICAL PARK
Second Line	:	SUITE 400
City	:	COLUMBIA
State	:	SC
Zip	:	29203-7516
Country	:	US
Telephone Number	:	803-434-6392
Fax Number	:	808-434-4309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/16/2007

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