=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942205109
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOEL J WATSON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2005
-----------------------------------------------------
Last Update Date | 01/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1217 W MARKET ST
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45327-1715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-855-7275
-----------------------------------------------------
Fax | 937-855-7279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2912 SPRINGBORO W STE 201
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45439-1674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-297-8996
-----------------------------------------------------
Fax | 937-855-7279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35-03-3754-W
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------