Provider Demographics
NPI:1821261819
Name:WATKINS, PEARLIE BRADFORD III (MD)
Entity Type:Individual
Prefix:
First Name:PEARLIE
Middle Name:BRADFORD
Last Name:WATKINS
Suffix:III
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 1:4402 SHIPYARD BLVD.
Mailing Address - Street 2:EASTERN CAROLINA EMERGENCY PHYSICIANS
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-202-3363
Mailing Address - Fax:
Practice Address - Street 1:4402 SHIPYARD BLVD.
Practice Address - Street 2:EASTERN CAROLINA EMERGENCY PHYSICIANS
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-202-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-00899207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917678Medicaid
NC1821261819OtherCHAMPUS
NCP01131867OtherRAILROAD MEDICARE
NC1821261819OtherCHAMPUS
NC5917678Medicaid