Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 9363 | NV |
NPI | 1780662817 |
---|---|
Provider Name | Dr. Troy Shannun Watson |
First Address | Las Vegas, NV 89121-3609 |
Second Address | Las Vegas, NV 89121-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 11/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200039182 | R.R. MEDICARE (01) | |
2018345 | (05) | NV |
5887740 | AETNA (01) | |
CC0232 | BXBS (01) | |
H05919 | (02) |