Healthcare Provider Details

I. General information

NPI: 1487759536
Provider Name (Legal Business Name): CHARLES T WATSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LEXINGTON AVE
ASHLAND KY
41101-2873
US

IV. Provider business mailing address

PO BOX 1717
ASHLAND KY
41105-1717
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-1188
  • Fax: 606-325-3843
Mailing address:
  • Phone: 606-324-1188
  • Fax: 606-325-3843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number17669
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: