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General NPI Number Information
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NPI Number | 1225129158
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Entity Type | Individual
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Provider Name | BRENT THOMAS WATSON MD
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2132 N 1700 W STE 230
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City | LAYTON
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State | UT
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Zip | 84041-7060
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Country | US
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Telephone | 801-773-3900
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Fax | 801-773-3900
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Provider Business Mailing Address
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Address Line | 640 WESTBROOK CIR
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City | KAYSVILLE
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State | UT
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Zip | 84037-1586
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Country | US
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Telephone | 801-589-3177
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Fax | 801-475-9499
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 187506-1205
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License Number State | UT
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