Healthcare Provider Details

I. General information

NPI: 1205968682
Provider Name (Legal Business Name): ROBERT E WATSON MD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 LUNDE RD
EVERSON WA
98247-9635
US

IV. Provider business mailing address

PO BOX 3191
BELLINGHAM WA
98227-3191
US

V. Phone/Fax

Practice location:
  • Phone: 360-398-8287
  • Fax: 360-398-7809
Mailing address:
  • Phone: 360-398-8287
  • Fax: 360-398-7809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT E WATSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 360-398-8287