Individual
TIMOTHY WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1630 E HERNDON AVE, FRESNO, CA 93720-3305
(559) 256-5200
(559) 256-5376
Mailing address
1630 E HERNDON AVE, FRESNO, CA 93720-3305
(559) 256-5200
(559) 256-5376
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
G54436
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0170233
STATE OF WASHINGTON
CA
01
—
P00005381
RAILROAD MEDICARE
CA
Enumeration date
11/28/2005
Last updated
05/09/2008
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