Individual
SAMUEL JACOB WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1640 BRYAN STATION RD STE 1, LEXINGTON, KY 40505-2144
(859) 288-2425
(859) 721-3918
Mailing address
496 SOUTHLAND DR, LEXINGTON, KY 40503-1827
(859) 288-2392
(859) 721-3918
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
46559
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108752
CERTIFICATION
KY
01
—
46559
KENTUCKY BOARD OF MEDICAL LICENSURE
KY
05
—
7100253290
—
KY
Enumeration date
07/03/2010
Last updated
03/13/2023
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