Healthcare Provider Details

I. General information

NPI: 1053792184
Provider Name (Legal Business Name): JAMES THOMAS WATSON MD,FRCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 LOUISE CRT
LONDON ONTARIO
N6G5G2
CA

IV. Provider business mailing address

315 LOUISE CRT
LONDON ONTARIO
N6G5G2
CA

V. Phone/Fax

Practice location:
  • Phone: 519-646-6100
  • Fax: 519-646-6116
Mailing address:
  • Phone: 519-646-6100
  • Fax: 519-646-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301045394
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: