MEDICARE: LA DONNA 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	208000000X	Pediatrics Physician	40561	CO

General Provider Information

NPI Number	:	1811999279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LA DONNA WATSON MD

Provider Business Mailing Address
First Line	:	3920 NORTH UNION BLVD
Second Line	:	PREMIER ARMY HEALTH CLINIC
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907
Country	:	US
Telephone Number	:	719-524-7601
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 N UNION BLVD
Second Line	:	PREMIER ARMY HEALTH CLINIC
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4900
Country	:	US
Telephone Number	:	719-524-7601
Fax Number	:

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	04/30/2010

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