MEDICARE: KIRK WATSON HS

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	247200000X	Other Technician		DC

General Provider Information

NPI Number	:	1285734103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK WATSON HS

Provider Business Mailing Address
First Line	:	300 E MAIN ST
Second Line	:	SUITE 1000
City	:	NORFOLK
State	:	VA
Zip	:	23510-1753
Country	:	US
Telephone Number	:	757-628-4375
Fax Number	:	757-628-4355

Provider Business Practice Location Address
First Line	:	300 E MAIN ST
Second Line	:	SUITE 1000
City	:	NORFOLK
State	:	VA
Zip	:	23510-1753
Country	:	US
Telephone Number	:	757-628-4375
Fax Number	:	757-628-4355

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/26/2007

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Directions to “ KIRK WATSON HS” Practice Location

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