Healthcare Provider Details

I. General information

NPI: 1265496103
Provider Name (Legal Business Name): DAVID D WATSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 W CENTRAL AVE
DELAWARE OH
43015-1410
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 740-615-1153
  • Fax: 740-615-1150
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35060740
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: