Individual
SUSAN JANE WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
114 E SOUTH HILLS DR, MARYVILLE, MO 64468-2659
(660) 562-2525
(660) 562-4303
Mailing address
114 E SOUTH HILLS DR, MARYVILLE, MO 64468-2659
(660) 562-4304
(660) 562-4303
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
110025
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208219816
—
MO
Enumeration date
01/28/2006
Last updated
11/09/2012
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