Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH0005178 | FL |
NPI | 1922167097 |
---|---|
Provider Name | Dr. Kimberly Watson |
First Address | Longwood, FL 32779-4880 |
Second Address | Longwood, FL 32779-4880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70794 | (02) | FL |