Provider Demographics
NPI:1518342344
Name:WATKINS INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:WATKINS INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:541-270-8966
Mailing Address - Street 1:407 N COAST HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3115
Mailing Address - Country:US
Mailing Address - Phone:541-270-8966
Mailing Address - Fax:
Practice Address - Street 1:407 N COAST HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3115
Practice Address - Country:US
Practice Address - Phone:541-270-8966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22558261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH15736Medicare UPIN