Provider Demographics
NPI:1972577021
Name:WATSON, MARY ALAYNICK (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALAYNICK
Last Name:WATSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-3902
Mailing Address - Country:US
Mailing Address - Phone:928-202-9187
Mailing Address - Fax:928-202-4666
Practice Address - Street 1:549 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3902
Practice Address - Country:US
Practice Address - Phone:928-202-9187
Practice Address - Fax:928-202-4666
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ519152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ188627Medicaid
AZ188627Medicaid