MEDICARE: KEITH A WATSON MD INC

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	207V00000X	Obstetrics & Gynecology Physician	35043758	OH

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	:	1265735062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEITH A WATSON MD INC

Provider Business Mailing Address
First Line	:	100 KAHOE LN
Second Line	:
City	:	YELLOW SPRINGS
State	:	OH
Zip	:	45387-1243
Country	:	US
Telephone Number	:	937-767-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 KAHOE LN
Second Line	:
City	:	YELLOW SPRINGS
State	:	OH
Zip	:	45387-1243
Country	:	US
Telephone Number	:	937-767-7311
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEITH A WATSON
Credential	:	MD
Telephone Number	:	937-767-7311

Provider Enumeration Date	:	12/16/2010
Last Update Date	:	01/27/2011

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