Healthcare Provider Details

I. General information

NPI: 1508111337
Provider Name (Legal Business Name): HANS ROBERT WATSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1654 W REUNION AVE STE 10B
SOUTH JORDAN UT
84095-4676
US

IV. Provider business mailing address

1654 W REUNION AVE STE 10B
SOUTH JORDAN UT
84095-4676
US

V. Phone/Fax

Practice location:
  • Phone: 406-404-6815
  • Fax:
Mailing address:
  • Phone: 801-349-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1284
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11831256-1204
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number77729
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: