Active NPI
Roosevelt Watson, MD
- Family Medicine Physician
- Las Vegas, NV
National Provider Identifier
1235104308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 9995
- Practice address
- 650 N Nellis
Las Vegas, NV 89110 - Phone
- (702) 459-7424
- NPI assigned
- Feb 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 9995 | NV | Primary |
Addresses
Primary practice location
650 N Nellis
Las Vegas, NV 89110
Mailing address
PO Box 15645
Las Vegas, NV 89114-5645
Phone (702) 242-7786
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160425000156 | NV | Order and Referring Only - Family Practice | 7911996616 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9995 | NV | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1235104308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 15645",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891145645",
"telephone_number": "702-242-7786",
"fax_number": "702-240-8790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 N NELLIS",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "89110",
"telephone_number": "702-459-7424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "ROOSEVELT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-21",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NV",
"license": "9995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.