MEDICARE: DR. MARSHALL TREDWAY WATSON JR. 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	207T00000X	Neurological Surgery Physician	39694	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39694	OTHER	TN	LICENSE

General Provider Information

NPI Number	:	1568461374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARSHALL TREDWAY WATSON JR. MD

Provider Business Mailing Address
First Line	:	465 SAINT MICHAELS DR
Second Line	:	SUITE 107
City	:	SANTA FE
State	:	NM
Zip	:	87505-7670
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	465 SAINT MICHAELS DR
Second Line	:	SUITE 107
City	:	SANTA FE
State	:	NM
Zip	:	87505-7670
Country	:	US
Telephone Number	:	505-988-3233
Fax Number	:

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	03/07/2023

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Directions to “ DR. MARSHALL TREDWAY WATSON JR. MD” Practice Location

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