Individual
JOHN O WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1301 S KOKE MILL RD, SPRINGFIELD, IL 62711-9252
(217) 547-9100
(217) 547-9247
Mailing address
PO BOX 9469, SPRINGFIELD, IL 62791-9469
(217) 547-9100
(217) 547-9247
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
036119109
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036119109
—
IL
01
—
P00608201
RR MEDICARE
IL
Enumeration date
07/11/2006
Last updated
04/13/2020
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