Provider Demographics
NPI:1053792184
Name:WATSON, JAMES THOMAS (MD,FRCPC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMAS
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD,FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 LOUISE CRT
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N6G5G2
Mailing Address - Country:CA
Mailing Address - Phone:519-646-6100
Mailing Address - Fax:519-646-6116
Practice Address - Street 1:315 LOUISE CRT
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:ONTARIO
Practice Address - Zip Code:N6G5G2
Practice Address - Country:CA
Practice Address - Phone:519-646-6100
Practice Address - Fax:519-646-6116
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045394208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301045394OtherMICHIGAN BOARD OF MEDICINE