MEDICARE: ANIKA NINA WATSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	79732	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073776126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANIKA NINA WATSON M.D.

Provider Business Mailing Address
First Line	:	2805 E OAKLAND PARK BLVD # 186
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1813
Country	:	US
Telephone Number	:	954-762-1027
Fax Number	:

Provider Business Practice Location Address
First Line	:	2805 E OAKLAND PARK BLVD # 186
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1813
Country	:	US
Telephone Number	:	954-762-1027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	11/02/2022

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