Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01069662A | IN |
N | 208000000X | Pediatrician | 43437 | KY |
Y | 2080P0205X | Pediatric Endocrinologist | 43437 | KY |
NPI | 1134246960 |
---|---|
Provider Name | Sara E Watson |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40202-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2007 |
Last Update Date | 10/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200990490 | (05) | IN |
7100132300 | (05) | KY |