MEDICARE: DR. JAN D WATSON M.D.

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	207VX0000X	Obstetrics Physician	24951	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	03-1881	OTHER	MEDICARE
2	Z148521	OTHER	MEDICARE
4	ZFQ31815	OTHER	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1336104108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAN D WATSON M.D.

Provider Business Mailing Address
First Line	:	2030 W BASELINE RD STE 182-235
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6579
Country	:	US
Telephone Number	:	602-899-3923
Fax Number	:	602-833-2549

Provider Business Practice Location Address
First Line	:	2030 W BASELINE RD
Second Line	:	SUITE 182-235
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6574
Country	:	US
Telephone Number	:	602-957-2407
Fax Number	:

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	06/19/2019

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