MEDICARE: DR. LOUIS H 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
1	208600000X	Surgery Physician	G32156	CA

General Provider Information

NPI Number	:	1730280827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS H WATSON MD

Provider Business Mailing Address
First Line	:	2058 N MILLS AVE
Second Line	:	#142
City	:	CLAREMONT
State	:	CA
Zip	:	91711
Country	:	US
Telephone Number	:	909-931-1800
Fax Number	:	909-931-1855

Provider Business Practice Location Address
First Line	:	99 N SAN ANTONIO AVE
Second Line	:	#140
City	:	UPLAND
State	:	CA
Zip	:	91786-4575
Country	:	US
Telephone Number	:	909-931-1800
Fax Number	:	909-931-1855

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	06/29/2011

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