Provider Demographics
NPI:1053337535
Name:WATSON, DONALD O (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:O
Last Name:WATSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-0419
Mailing Address - Country:US
Mailing Address - Phone:231-627-1438
Mailing Address - Fax:231-627-1471
Practice Address - Street 1:740 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2220
Practice Address - Country:US
Practice Address - Phone:231-627-1282
Practice Address - Fax:231-627-1850
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110A610070OtherGROUP BLUE CROSS - IM
MI4443438Medicaid
MI4745644Medicaid
MI1151600184OtherINDIVIDUAL BLUE CROSS
MI010A660000OtherGROUP BLUE CROSS - HOSP
MI010A660000OtherGROUP BLUE CROSS - HOSP
MI4745644Medicaid