Provider Demographics
NPI:1366523706
Name:WATSON, ROBERT EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EUGENE
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:PO BOX 3191
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-3191
Mailing Address - Country:US
Mailing Address - Phone:360-398-8287
Mailing Address - Fax:360-398-7809
Practice Address - Street 1:6715 LUNDE RD
Practice Address - Street 2:
Practice Address - City:EVERSON
Practice Address - State:WA
Practice Address - Zip Code:98247-9635
Practice Address - Country:US
Practice Address - Phone:360-398-8287
Practice Address - Fax:360-398-7809
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000126752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA001400244Medicare PIN