Basic Information
| Provider Information | |||||||||
| NPI: | 1396858247 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARNOLD | ||||||||
| FirstName: | WATSON | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 4TH STREET | ||||||||
| Address2: | STOP 9903 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794309903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067437336 | ||||||||
| FaxNumber: | 8067437329 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 4TH STREET | ||||||||
| Address2: | STOP 9406 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794309406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067437336 | ||||||||
| FaxNumber: | 8067437329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 10/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0210X | D6930 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 10028697 | 01 | TX | AMERIGROUP PIN | OTHER | 137831707 | 01 | TX | CSHCN IND TPI NUMBER | OTHER | 1416412 | 01 | TX | FIRSTHEALTH PIN | OTHER | 4243069 | 01 | TX | AETNA PIN | OTHER | 822100 | 01 | TX | UHC PIN | OTHER | 124027 | 01 | TX | SUPERIOR PIN | OTHER | 137831709 | 05 | TX | MEDICAID | 138412511 | 05 | TX | MEDICAID | 140442854 | 05 | TX | MEDICAID | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER | 107700100 | 01 | TX | FIRSTCARE PIN | OTHER | 4605937 | 01 | TX | CIGNA PIN | OTHER | 87Y110 | 01 | TX | BCBSTX IND PIN | OTHER | 378120 | 01 | TX | PHCS PIN | OTHER |