MEDICARE: ROGER D. 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	207R00000X	Internal Medicine Physician	42990	WI
2	208000000X	Pediatrics Physician	42990	WI

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	:	1932172327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER D. WATSON M.D.

Provider Business Mailing Address
First Line	:	N17 W24100 RIVERWOOD DRIVE SUITE 250
Second Line	:	PROHEALTH CARE MEDICAL ASSOCIATES INC.
City	:	WAUKESHA
State	:	WI
Zip	:	53188-1177
Country	:	US
Telephone Number	:	262-928-4100
Fax Number	:	262-928-5835

Provider Business Practice Location Address
First Line	:	2750 GOLF ROAD
Second Line	:	PROHEALTH CARE MEDICAL ASSOCIATES
City	:	DELAFIELD
State	:	WI
Zip	:	53018
Country	:	US
Telephone Number	:	262-928-4900
Fax Number	:	262-928-4960

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	12/30/2024

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