MEDICARE: DR. RANDY CHARLES WATSON MD

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	3188	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487653655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY CHARLES WATSON MD

Provider Business Mailing Address
First Line	:	PO BOX 11889
Second Line	:
City	:	ZEPHYR COVE
State	:	NV
Zip	:	89448-3889
Country	:	US
Telephone Number	:	775-588-3636
Fax Number	:	775-588-1299

Provider Business Practice Location Address
First Line	:	212 ELKS POINT ROAD
Second Line	:	SUITE 200
City	:	ZEPHYR COVE
State	:	NV
Zip	:	89448
Country	:	US
Telephone Number	:	775-588-3636
Fax Number	:	775-588-1299

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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