Provider Demographics
NPI:1366544710
Name:WATSON, JAMES BERNARD (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BERNARD
Last Name:WATSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31 E FORNANCE ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3311
Mailing Address - Country:US
Mailing Address - Phone:610-292-9547
Mailing Address - Fax:610-292-9548
Practice Address - Street 1:31 E FORNANCE ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3311
Practice Address - Country:US
Practice Address - Phone:610-292-9547
Practice Address - Fax:610-292-9548
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010947L207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018638870003Medicaid
PA053700Medicare ID - Type Unspecified
PA0018638870003Medicaid