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General NPI Number Information
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NPI Number | 1780659920
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Entity Type | Individual
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Provider Name | ALEX BENTON WATSON MD
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Gender | Male
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 2315 8TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-7301
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Country | US
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Telephone | 208-746-1383
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Fax | 208-746-6348
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Provider Business Mailing Address
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Address Line | 2315 8TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-7301
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Country | US
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Telephone | 208-746-1383
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Fax | 208-746-6348
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2003025568
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD60171764
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | M-11086
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License Number State | ID
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