Healthcare Provider Details

I. General information

NPI: 1245429471
Provider Name (Legal Business Name): MICHAEL PAUL WATSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8649 HIGHWAY 165 N STE 3
MONROE LA
71203-8965
US

IV. Provider business mailing address

8649 HIGHWAY 165 N STE 3
MONROE LA
71203-8965
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-1662
  • Fax: 318-388-1666
Mailing address:
  • Phone: 318-388-1662
  • Fax: 318-388-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD.012676
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: