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General NPI Number Information
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NPI Number | 1780922740
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Entity Type | Organization
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Legal Business Name | PAIRED HEALTH PHYSICIAN GROUP PA
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Dates
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Enumeration Date | 01/27/2013
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Last Update Date | 01/27/2013
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Provider Practice Location Address
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Address Line | 8310 BANDFORD WAY
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City | RALEIGH
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State | NC
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Zip | 27615-2752
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Country | US
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Telephone | 919-719-0654
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Fax | 919-443-1122
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Provider Business Mailing Address
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Address Line | 8310 BANDFORD WAY
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City | RALEIGH
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State | NC
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Zip | 27615-2752
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Country | US
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Telephone | 919-719-0654
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Fax | 919-443-1122
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL C WATSON JR.
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Credential | M.D.
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Telephone | 919-719-0654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 39227
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License Number State | NC
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