MEDICARE: MR. TERRY F WATSON CRNA

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	367500000X	Certified Registered Nurse Anesthetist	200460034CRNA	OR
2	367500000X	Certified Registered Nurse Anesthetist	ARNP 1479742	FL

General Provider Information

NPI Number	:	1548295348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRY F WATSON CRNA

Provider Business Mailing Address
First Line	:	4060 EL PRADO BLVD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-6310
Country	:	US
Telephone Number	:	305-608-4432
Fax Number	:

Provider Business Practice Location Address
First Line	:	4060 EL PRADO BLVD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-6310
Country	:	US
Telephone Number	:	305-608-4432
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	02/16/2011

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