Healthcare Provider Details

I. General information

NPI: 1598778789
Provider Name (Legal Business Name): MICHAEL DENNIS WATSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4409 SUN N LAKE BLVD
SEBRING FL
33872-2170
US

IV. Provider business mailing address

4409 SUN N LAKE BLVD
SEBRING FL
33872-2170
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-3480
  • Fax: 863-402-3483
Mailing address:
  • Phone: 863-402-3480
  • Fax: 863-402-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036082146
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME134541
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: