MEDICARE: LARRY C 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	208600000X	Surgery Physician	D9711	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AJ295	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8GD916	OTHER	TX	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8ER636	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1174551402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY C WATSON M.D.

Provider Business Mailing Address
First Line	:	2060 SPACE PARK DR
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77058-3600
Country	:	US
Telephone Number	:	281-333-1703
Fax Number	:	281-333-5970

Provider Business Practice Location Address
First Line	:	2060 SPACE PARK DR
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77058-3600
Country	:	US
Telephone Number	:	281-333-1703
Fax Number	:	281-333-5970

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	01/17/2017

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Directions to “ LARRY C WATSON M.D.” Practice Location

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