Provider Demographics
NPI:1174514194
Name:WATKINS, CHAD C (DPM)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:C
Last Name:WATKINS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 E DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7647
Mailing Address - Country:US
Mailing Address - Phone:352-805-4317
Mailing Address - Fax:352-805-4298
Practice Address - Street 1:914 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7647
Practice Address - Country:US
Practice Address - Phone:352-805-4317
Practice Address - Fax:352-805-4298
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2769213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390469500Medicaid
FL390469500Medicaid
FL46582WMedicare PIN