Provider Demographics
NPI:1619132321
Name:JEREMY P. WATKINS MD, L.L.C
Entity Type:Organization
Organization Name:JEREMY P. WATKINS MD, L.L.C
Other - Org Name:JEREMY P. WATKINS MD, L.L.C
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:P
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-335-8151
Mailing Address - Street 1:1001 12TH AVE
Mailing Address - Street 2:SUITE150
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3926
Mailing Address - Country:US
Mailing Address - Phone:817-335-8151
Mailing Address - Fax:817-335-2670
Practice Address - Street 1:1001 12TH AVE
Practice Address - Street 2:SUITE150
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3926
Practice Address - Country:US
Practice Address - Phone:817-335-8151
Practice Address - Fax:817-335-2670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEREMY P. WATKINS MD, L.L.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8419174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty