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General NPI Number Information
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NPI Number | 1063874584
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Entity Type | Individual
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Provider Name | JOSEPH THOMAS WATSON D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 1890 LPGA BLVD STE 230
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7131
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Country | US
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Telephone | 386-279-4062
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Fax |
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Provider Business Mailing Address
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Address Line | 6910 MAIN ST APT 357
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City | MIAMI LAKES
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State | FL
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Zip | 33014-7014
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Country | US
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Telephone | 561-644-3565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3944
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License Number State | FL
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