=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134374424
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER BRUCE WATSON PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2008
-----------------------------------------------------
Last Update Date | 05/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18707 HARDY OAK BLVD STE 230
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-4890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-789-7246
-----------------------------------------------------
Fax | 888-880-9323
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 STONE OAK LOOP SUITE 103
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-3510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-268-0129
-----------------------------------------------------
Fax | 210-497-8333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA06007
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------