Provider Demographics
NPI:1326240425
Name:WATKINS, BRUCE JAMES (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:JAMES
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 1:3369 MERLIN DR STE B
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7405
Mailing Address - Country:US
Mailing Address - Phone:844-919-4263
Mailing Address - Fax:833-513-0980
Practice Address - Street 1:3369 MERLIN DR STE B
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7405
Practice Address - Country:US
Practice Address - Phone:844-919-4263
Practice Address - Fax:833-513-0980
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT80664388017208600000X
WI48738-020208600000X
SD88732086S0105X
IDM-137632086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1326240425Medicaid
ID1326240425Medicaid
IA1326240425Medicaid
NE1326240425Medicaid
IA1295480002Medicare NSC
SD1295480001Medicare NSC