Healthcare Provider Details

I. General information

NPI: 1184039877
Provider Name (Legal Business Name): NATHAN D. WATSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2014
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12955 PALMS WEST DR STE 100
LOXAHATCHEE FL
33470-9212
US

IV. Provider business mailing address

7593 W BOYNTON BEACH BLVD STE 220
BOYNTON BEACH FL
33437-6162
US

V. Phone/Fax

Practice location:
  • Phone: 561-641-2926
  • Fax: 561-968-0660
Mailing address:
  • Phone: 561-649-7000
  • Fax: 888-316-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS14670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: