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NPI Code Detail

MEDICARE: JACK R WATSON MD

MEDICARE: JACK R 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
1207Q00000XFamily Medicine PhysicianA65310CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700986858
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK R WATSON MD
Provider Business Mailing Address
First Line : 550 WATER ST STE A
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95060-4126
Country : US
Telephone Number : 831-425-0420
Fax Number : 831-425-0185
Provider Business Practice Location Address
First Line : 550 WATER ST STE A
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95060-4126
Country : US
Telephone Number : 831-425-0420
Fax Number : 831-425-0185
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 12/21/2021

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Directions to “ JACK R WATSON MD” Practice Location

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