Individual
DAVIN WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2125 CRYSTAL GROVE DR, LAKELAND, FL 33801-6875
(863) 688-2334
Mailing address
2125 CRYSTAL GROVE DR, LAKELAND, FL 33801-6875
(863) 688-2334
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
263930
MA
2085R0202X
Diagnostic Radiology Physician
Primary
ME142419
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107914000
—
FL
01
—
B769S
BCBS
FL
01
—
NS297
MEDICARE PTAN OHRI
FL
01
—
PS940
MEDICARE PTAN OHMG
FL
Enumeration date
07/07/2015
Last updated
03/28/2023
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