Healthcare Provider Details

I. General information

NPI: 1033568761
Provider Name (Legal Business Name): JACQUELINE WATCHMAKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 N SCOTTSDALE RD
SCOTTSDALE AZ
85254-5216
US

IV. Provider business mailing address

10900 N SCOTTSDALE RD
SCOTTSDALE AZ
85254-5216
US

V. Phone/Fax

Practice location:
  • Phone: 480-210-1988
  • Fax:
Mailing address:
  • Phone: 262-391-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number63274
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number267817
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: