National Provider Identifier
Wallace Carlisle Watson Jr., PA
Wallace Carlisle Watson Jr., PA is listed in the NPPES registry with a primary specialty of Physician Assistant in Cuba, NY and a listed phone number of (585) 968-4357.
Profile Overview
- NPI
- 1073554150
- Provider Type
- Individual
- Primary Specialty
- Physician Assistant
- Enumeration Date
- June 09, 2006
- Last Updated
- May 28, 2013
Practice Location
- 21 E Main St
- Cuba, NY 14727-1205
Phone: (585) 968-4357
Mailing Address
- 2211 W State St
- Suite 121
- Olean, NY 14760-1951
Specialties
- Physician Assistant (363A00000X)
- General Practice Physician (208D00000X)
Full Record
- NPI
- 1073554150
- Entity Type
- Individual
- Last Name
- Watson
- First Name
- Wallace
- Middle Name
- Carlisle
- Name Prefix
- Mr.
- Name Suffix
- Jr.
- Credential
- PA
- Mailing Street Address
- 2211 W State St
- Mailing Address Line 2
- Suite 121
- Mailing City
- Olean
- Mailing State
- NY
- Mailing ZIP Code
- 14760-1951
- Mailing Country
- US
- Mailing Phone
- (716) 372-2708
- Mailing Fax
- (716) 372-8682
- Practice Street Address
- 21 E Main St
- Practice City
- Cuba
- Practice State
- NY
- Practice ZIP Code
- 14727-1205
- Practice Country
- US
- Practice Phone
- (585) 968-4357
- Practice Fax
- (585) 968-4356
- Enumeration Date
- June 09, 2006
- Last Updated
- May 28, 2013
- Sex
- Male
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physician Assistant (363A00000X), General Practice Physician (208D00000X)
- Other Identifiers
- 0490352 (NY, Iha), 00010257702 (Univera), 407113852 (Railroad Medicare), 000508499002 (NY, Bcwny), 2598491 (Ghi), 01531593 (NY)