MEDICARE: MR. MARK A WATSON CPO

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	222Z00000X	Orthotist	ORT0000000069	TN
2	224P00000X	Prosthetist	PRO0000000058	TN

General Provider Information

NPI Number	:	1215277728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK A WATSON CPO

Provider Business Mailing Address
First Line	:	1707 STATE ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 STATE ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2929
Country	:	US
Telephone Number	:	615-327-2882
Fax Number	:

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

Provider Enumeration Date	:	02/20/2013
Last Update Date	:	02/20/2013

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