=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558395640
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSE VERNON WATSON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 08/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 POSEY AVE
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76634-1289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-675-8322
-----------------------------------------------------
Fax | 254-675-2246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 549
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76634-0549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-675-8322
-----------------------------------------------------
Fax | 254-675-2246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | K2820
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------