Healthcare Provider Details

I. General information

NPI: 1609003375
Provider Name (Legal Business Name): TANYA LEIGH WATSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA LEIGH PORTER DO

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 GLEN SPRINGS DR
FREMONT OH
43420-3229
US

IV. Provider business mailing address

2200 JEFFERSON AVE 5TH FL
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-333-2798
  • Fax: 567-201-2658
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number34012431
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA-1768-13
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2072
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0102202844
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: