Provider Demographics
NPI:1326066911
Name:WATKINS, CARL L (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:L
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-0595
Mailing Address - Country:US
Mailing Address - Phone:270-885-3414
Mailing Address - Fax:270-885-7631
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BLDG D
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-926-8171
Practice Address - Fax:270-852-7954
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY395462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6412337500Medicaid
KY000000569164OtherBCBS (COOPERATIVE HEALTH SERVICES INC.)
KY3397757Medicare PIN
KYP00327425Medicare PIN
KY000000569164OtherBCBS (COOPERATIVE HEALTH SERVICES INC.)