Individual
WILSON TATSUO WATANABE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
122 CHESTER PARK CIR, CHESTERFIELD, SC 29709-1009
(843) 623-2687
Mailing address
122 CHESTER PARK CIR, CHESTERFIELD, SC 29709-1009
(843) 623-2687
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD6441
ME
Other
Enumeration date
05/01/2012
Last updated
05/01/2012
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