Healthcare Provider Details

I. General information

NPI: 1750787776
Provider Name (Legal Business Name): BERNARD WATSON III CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROOKLYN AVE
SAN ANTONIO TX
78215-1608
US

IV. Provider business mailing address

801 BROOKLYN AVE
SAN ANTONIO TX
78215-1608
US

V. Phone/Fax

Practice location:
  • Phone: 210-227-2471
  • Fax: 210-224-4795
Mailing address:
  • Phone: 210-227-2471
  • Fax: 210-224-4795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number1634
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: