Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Individual
MR. WALLACE CARLISLE WATSON JR.
Active
Individual
MR. WALLACE CARLISLE WATSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
0012551
NY
363A00000X
Physician Assistant
Primary
001255
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010257702
UNIVERA
—
01
—
000508499002
BCWNY
NY
05
—
01531593
—
NY
01
—
0490352
IHA
NY
01
—
2598491
GHI
—
01
—
407113852
RAILROAD MEDICARE
—
Enumeration date
06/09/2006
Last updated
05/28/2013
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up