Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | R3617 | AR |
NPI | 1003881848 |
---|---|
Provider Name | Dr. Vye Branch Watson |
First Address | Jonesboro, AR 72401 |
Second Address | Jonesboro, AR 72401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E59598 | (02) |