Provider Demographics
NPI:1396814737
Name:WATKINS, JAMES FREASE (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FREASE
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3308
Mailing Address - Country:US
Mailing Address - Phone:508-941-7000
Mailing Address - Fax:508-941-0895
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-941-7000
Practice Address - Fax:508-941-0895
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81718208600000X, 2086S0102X, 2086S0127X
KS04-356262086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0035960OtherNHP
MAAA41810OtherHPHC
MA7577762OtherCIGNA
MA1076810OtherAETNA HMO
MA4659658OtherAETNA PPO
MAJ29266OtherBCBS
MA17-02030OtherUNITED
MA1076810OtherAETNA HMO
MA7577762OtherCIGNA