MEDICARE: JERILYN 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	207R00000X	Internal Medicine Physician	30995	AZ

General Provider Information

NPI Number	:	1871589986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERILYN WATSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 28757
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-0162
Country	:	US
Telephone Number	:	602-550-0724
Fax Number	:	480-636-7642

Provider Business Practice Location Address
First Line	:	2528 W VIA PERUGIA
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-6630
Country	:	US
Telephone Number	:	602-550-0724
Fax Number	:	480-636-7642

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	02/20/2018

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