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Shaun Watson

NPI Registration Record

Provider / OrganizationNPIDate Certified
SHAUN WATSON15084647852020-10-11
Entity TypeIndividual
Provider Name Shaun Watson
Practice Office Address7272 EASTERN AVE SE
GRAND RAPIDS, MI US
Practice Office Telephone2313835606
Mailing Address7272 EASTERN AVE SE
GRAND RAPIDS, MI 495087436 US
Business Telephone2313835606
HPT Codes
CodeLicense NoState
224Z00000X PRIMARY5202007691 MI
193400000X MULTGroup Code
OPI Codes

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