Provider Demographics
NPI:1174620389
Name:JOSEPH R. WATKINS MD PC
Entity type:Organization
Organization Name:JOSEPH R. WATKINS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-473-7035
Mailing Address - Street 1:1055 N 300 W STE 404
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3359
Mailing Address - Country:US
Mailing Address - Phone:801-357-7401
Mailing Address - Fax:801-357-3708
Practice Address - Street 1:1055 N 300 W STE 404
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3359
Practice Address - Country:US
Practice Address - Phone:801-357-7401
Practice Address - Fax:801-357-3708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17066512052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057722Medicare PIN