Healthcare Provider Details

I. General information

NPI: 1659728087
Provider Name (Legal Business Name): CLAY WATSON MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 BUCHTEL BLVD #100984
DENVER CO
80250-7501
US

IV. Provider business mailing address

3800 BUCHTEL BLVD #100984
DENVER CO
80250-7501
US

V. Phone/Fax

Practice location:
  • Phone: 303-507-9178
  • Fax: 720-932-4404
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46695
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number46695
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number46635
License Number StateCO

VIII. Authorized Official

Name: DR. CLAY WATSON
Title or Position: PRESIDENT
Credential: MD
Phone: 303-507-9178