1275591125 NPI number — RHODA WATSON NP

Table of content: RHODA WATSON NP (NPI 1275591125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275591125 NPI number — RHODA WATSON NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATSON
Provider First Name:
RHODA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275591125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 RED OAK ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON OAKS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76087-7319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-371-0799
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1411 N BECKLEY AVE
Provider Second Line Business Practice Location Address:
PAVILLION III, 2ND FLOOR, SUITE 268
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-947-4448
Provider Business Practice Location Address Fax Number:
214-947-4446
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  610032 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00883507 . This is a "PALMETTO RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DQ5280 . This is a "MEDICARE RR PALMETTO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 175116601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com