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General NPI Number Information
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NPI Number | 1255524435
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Entity Type | Individual
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Provider Name | DEREK PHILIP WATSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 11200 GOVERNOR MANLY WAY STE 309
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City | RALEIGH
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State | NC
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Zip | 27614-7375
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Country | US
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Telephone | 919-562-9410
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Fax | 919-562-2948
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Provider Business Mailing Address
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Address Line | PO BOX 1107
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City | WAKE FOREST
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State | NC
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Zip | 27588-1107
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Country | US
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Telephone | 919-562-9410
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2008-00177
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2008-00177
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License Number State | NC
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