Healthcare Provider Details

I. General information

NPI: 1932172327
Provider Name (Legal Business Name): ROGER D. WATSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 GOLF ROAD PROHEALTH CARE MEDICAL ASSOCIATES
DELAFIELD WI
53018
US

IV. Provider business mailing address

N17 W24100 RIVERWOOD DRIVE SUITE 250 PROHEALTH CARE MEDICAL ASSOCIATES INC.
WAUKESHA WI
53188-1177
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-4900
  • Fax: 262-928-4960
Mailing address:
  • Phone: 262-928-4100
  • Fax: 262-928-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42990
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42990
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: