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NPI Code Detail

MEDICARE: DR. KENNETH R WATSON DO

MEDICARE: DR. KENNETH R WATSON DO
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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianR8692MO
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician20A9489CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114905221
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH R WATSON DO
Provider Business Mailing Address
First Line : 14275 MIDWAY RD
Second Line : SUITE 400
City : ADDISON
State : TX
Zip : 75001-3614
Country : US
Telephone Number : 214-932-8029
Fax Number : 610-271-4245
Provider Business Practice Location Address
First Line : 10330 HICKMAN MILLS DR
Second Line :
City : KANSAS CITY
State : MO
Zip : 64137-1618
Country : US
Telephone Number : 816-412-7004
Fax Number : 816-763-7536
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2006
Last Update Date : 11/26/2014

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Directions to “ DR. KENNETH R WATSON DO” Practice Location

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