MEDICARE: DR. SIMON C 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	207P00000X	Emergency Medicine Physician	30538	SC
2	207P00000X	Emergency Medicine Physician	2004-00774	NC

General Provider Information

NPI Number	:	1982732244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMON C WATSON MD

Provider Business Mailing Address
First Line	:	169 ASHLEY AVE
Second Line	:	MSC 300
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8905
Country	:	US
Telephone Number	:	843-792-9707
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 ASHLEY AVE
Second Line	:	MSC 300
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8905
Country	:	US
Telephone Number	:	843-792-9707
Fax Number	:

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	10/15/2020

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