1992795652 NPI number — DOUGLAS J WATKINS M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992795652 NPI number — DOUGLAS J WATKINS M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WATKINS

Provider First Name:

DOUGLAS

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1992795652

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/26/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3366 OAKDALE AVENUE NO

Provider Second Line Business Mailing Address:

#315 NORTH CLINIC PA

Provider Business Mailing Address City Name:

ROBBINSDALE

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55422-2948

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

763-587-7900

Provider Business Mailing Address Fax Number:

763-587-7989

Provider First Line Business Practice Location Address:

1900 CENTRACARE CIR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SAINT CLOUD

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

56303-5000

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

320-229-4917

Provider Business Practice Location Address Fax Number:

320-229-5181

Provider Enumeration Date:

10/25/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  31999 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207QG0300X , with the licence number: 31999 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0707716 . This is a "MEDICA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
• Identifier: COMP . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
• Identifier: 2114087 . This is a "FIRST HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 761592200 . This is a "MEDICAL ASSISTANCE (MA)" identifier . This identifiers is of the category "OTHER".
• Identifier: HP22747 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
• Identifier: COMP . This is a "ONE HEALTH PLAN/GREAT WST" identifier . This identifiers is of the category "OTHER".
• Identifier: 110935 . This is a "U-CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 601023 . This is a "ARAZ GROUP/AMERICAS PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: COMP . This is a "MMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 080073015 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 86D81WA . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 438598 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
• Identifier: 761592200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".