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Individual

DR. HERMAN WATSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1734 E 63RD ST, SUITE 460, KANSAS CITY, MO 64110-3543
(816) 523-1177
(816) 523-2521
Mailing address
209 NW PONDEROSA ST, LEES SUMMIT, MO 64064-1462
(816) 523-1177
(816) 523-2521

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R6315
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10000400A
KS
05
200473916
MO
Enumeration date
03/14/2006
Last updated
07/16/2010
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