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Individual
MR. JEROME BRADFIELD WATSON
Active
Individual
MR. JEROME BRADFIELD WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
GNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP108606
TX
363LG0600X
Gerontology Nurse Practitioner
605190
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029325001
—
TX
05
—
029325002
—
TX
05
—
100082540A
—
OK
05
—
145430758
—
AR
05
—
160262762
—
AR
05
—
29325004
—
TX
01
—
500004259
RAILROAD MEDICARE
AR
01
—
500004259
RAILROAD MEDICARE
TX
01
—
5U081
MEDICARE - LEGACY NUMBER
AR
01
—
8D9579
MEDICARE - LEGACY NUMBER
TX
01
—
P00267929
TX RAILROAD MEDICARE
TX
Enumeration date
05/30/2005
Last updated
08/02/2024
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