Provider Demographics
NPI:1659546083
Name:WATSON, JEANE PALMER (DPM)
Entity type:Individual
Prefix:DR
First Name:JEANE
Middle Name:PALMER
Last Name:WATSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 N PECOS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-4400
Mailing Address - Country:US
Mailing Address - Phone:702-791-9168
Mailing Address - Fax:702-791-9242
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9168
Practice Address - Fax:702-791-9242
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-27
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC601213E00000X, 213ES0131X
GAPOD001066213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I480052OtherINDIVIDUAL MEDICARE PTAN
SCAA39819277OtherINDIVIDUAL MEDICARE PTAN
GA355230972AMedicaid
GAP00884480OtherRAILROAD MEDICARE PROVIDER PTAN
SCDQ9090OtherRAILROAD MEDICARE GROUP PTAN
GAP00884480OtherRAILROAD MEDICARE PROVIDER PTAN
SCAA39819277OtherINDIVIDUAL MEDICARE PTAN
GA511G700902OtherGROUP MEDICARE PTAN
GADQ9092OtherRAILROAD MEDICARE GROUP PTAN
GA355230972AMedicaid