Provider Demographics
NPI:1962083949
Name:WATSON, MICAH KEITH (DO)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:KEITH
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 1:786 D STREET
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99505-4000
Mailing Address - Country:US
Mailing Address - Phone:907-384-0600
Mailing Address - Fax:
Practice Address - Street 1:786 D STREET
Practice Address - Street 2:
Practice Address - City:JBER
Practice Address - State:AK
Practice Address - Zip Code:99505-0004
Practice Address - Country:US
Practice Address - Phone:904-384-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA95592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine