Provider Demographics
NPI:1699188490
Name:WATKINS, BRENTON THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:BRENTON
Middle Name:THOMAS
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRENT
Other - Middle Name:THOMAS
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7507 E. TANQUE VERDE ROAD
Mailing Address - Street 2:101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715
Mailing Address - Country:US
Mailing Address - Phone:520-722-2585
Mailing Address - Fax:520-722-1097
Practice Address - Street 1:7507 E. TANQUE VERDE ROAD
Practice Address - Street 2:101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715
Practice Address - Country:US
Practice Address - Phone:520-722-2585
Practice Address - Fax:520-722-1097
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53883208000000X
AZR74381208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics