MEDICARE: GORDON KIRK WATSON MD

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	207RC0000X	Cardiovascular Disease Physician	24145	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	060057125	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	005502492	OTHER	AZ	CIGNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5725261	OTHER	AZ	AETNA
4	AZ0860260	OTHER	AZ	BCBS OF ARIZONA
5	10055691	OTHER	AZ	PPO NEXT
7	2198510	OTHER	AZ	GHI
8	25-00273	OTHER	AZ	UNITED HEALTHCARE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	1Z3643	OTHER	AZ	HEALTH NET
11	933773	OTHER	AZ	FIRST HEALTH
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	5073471	OTHER	AZ	CCN

General Provider Information

NPI Number	:	1225031131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON KIRK WATSON MD

Provider Business Mailing Address
First Line	:	3709 N CAMPBELL AVE STE 201
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1563
Country	:	US
Telephone Number	:	520-838-2122
Fax Number	:	520-838-2245

Provider Business Practice Location Address
First Line	:	1238 W ORANGE GROVE RD STE 103
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-2950
Country	:	US
Telephone Number	:	520-838-3540
Fax Number	:	520-325-3526

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/16/2021

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