Provider Demographics
NPI:1689934598
Name:MYRON H. WATKINS, MD PA
Entity Type:Organization
Organization Name:MYRON H. WATKINS, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:HINTON
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:214-630-3262
Mailing Address - Street 1:5939 HARRY HINES BLVD
Mailing Address - Street 2:SUITE 323
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6246
Mailing Address - Country:US
Mailing Address - Phone:214-630-3262
Mailing Address - Fax:214-630-3397
Practice Address - Street 1:5939 HARRY HINES BLVD
Practice Address - Street 2:SUITE 323
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6246
Practice Address - Country:US
Practice Address - Phone:214-630-3262
Practice Address - Fax:214-630-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0754261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A986Medicare UPIN