Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | A38672 | CA |
N | 2080P0216X | Pediatric Rheumatologist | A38672 | CA |
NPI | 1902814056 |
---|---|
Provider Name | Robert D. Watson |
First Address | Carmichael, CA 95608-6018 |
Second Address | Sacramento, CA 95816-5219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A28696 | (02) |