Provider Demographics
NPI:1104072636
Name:WATSON, CLAY CONRAD (MD)
Entity type:Individual
Prefix:DR
First Name:CLAY
Middle Name:CONRAD
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:303-750-8000
Practice Address - Street 1:1550 S POTOMAC ST STE 270
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5456
Practice Address - Country:US
Practice Address - Phone:303-750-1800
Practice Address - Fax:303-750-8000
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46695207R00000X, 207RI0200X
MS28623207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70335842Medicaid
COCOA100646Medicare PIN