Individual
JACQUELYN R WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 N PARK ST, WEST MICHIGAN CANCER CENTER, KALAMAZOO, MI 49007-3731
(269) 373-7474
Mailing address
601 JOHN ST, BOX 42, KALAMAZOO, MI 49007-5341
(269) 341-7806
(269) 341-8743
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
404424
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C96059
BCBSM
MI
05
—
1801881065
—
MI
05
—
292222010
—
MI
Enumeration date
09/14/2005
Last updated
09/21/2009
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