MEDICARE: MRS. BRENDA LUCILLE HARRIS-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	207V00000X	Obstetrics & Gynecology Physician	ME93727	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1770581167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA LUCILLE HARRIS-WATSON MD

Provider Business Mailing Address
First Line	:	1801 LEE RD STE 165
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2127
Country	:	US
Telephone Number	:	407-975-0406
Fax Number	:	407-975-0407

Provider Business Practice Location Address
First Line	:	400 CELEBRATION PL
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747
Country	:	US
Telephone Number	:	407-975-0406
Fax Number	:	407-975-0407

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	08/03/2018

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