Provider Demographics
NPI:1730280827
Name:WATSON, LOUIS H (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:H
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LOUIS
Other - Middle Name:H
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2058 N MILLS AVE
Mailing Address - Street 2:#142
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:909-931-1800
Mailing Address - Fax:909-931-1855
Practice Address - Street 1:99 N SAN ANTONIO AVE
Practice Address - Street 2:#140
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4575
Practice Address - Country:US
Practice Address - Phone:909-931-1800
Practice Address - Fax:909-931-1855
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32156208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW45034Medicare UPIN
CAG32156Medicare PIN