Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD5365 | HI |
NPI | 1013082247 |
---|---|
Provider Name | Dr. Edward Joseph Watson JR. |
First Address | Tripler Army Medical Center, HI 96859-5001 |
Second Address | Tripler Army Medical Center, HI 96859-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 11/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F46465 | (02) | FL |