Healthcare Provider Details

I. General information

NPI: 1568430163
Provider Name (Legal Business Name): CINDY M WATSON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 WILLISTON PARK POINT SUITE 1009
LAKE MARY FL
32746-2114
US

IV. Provider business mailing address

925 WILLISTON PARK POINT SUITE 1009
LAKE MARY FL
32746-2114
US

V. Phone/Fax

Practice location:
  • Phone: 407-323-2566
  • Fax: 407-324-3577
Mailing address:
  • Phone: 407-323-2566
  • Fax: 407-324-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO0001968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: