Provider Demographics
NPI:1346962107
Name:WATINS, BO JAMES
Entity Type:Individual
Prefix:
First Name:BO
Middle Name:JAMES
Last Name:WATINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8058
Mailing Address - Country:US
Mailing Address - Phone:360-812-7220
Mailing Address - Fax:844-807-0646
Practice Address - Street 1:2026 DIVISION ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8058
Practice Address - Country:US
Practice Address - Phone:360-812-7220
Practice Address - Fax:844-807-0646
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61304708390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program