Provider Demographics
NPI:1407945991
Name:WATKINS, RANDALL G (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:G
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 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4054
Practice Address - Fax:682-885-7497
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4799207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5627997OtherCCN PIN
TX10018631OtherAMERIGROUP PIN
TX140442853OtherCSHCN GROUP TPI
TX2547791OtherUHC PIN
TX7617679OtherAETNA PIN
TX137345809OtherMEDICAID GROUP TPI
TX140442853Medicaid
1447220850OtherGRP NPI NUMBER
TX173150702Medicaid
TX5627997OtherFIRSTHEALTH PIN
TX00N47FOtherMEDICARE GROUP PIN
TX8K3992OtherBCBSTX IND PIN
TX00N47FOtherBCBSTX GRP PIN
TX173150701Medicaid
TX287669OtherPHCS PIN
TX5029032OtherCIGNA PIN
TX140442853OtherCSHCN GROUP TPI
TX8E0054Medicare PIN