Provider Demographics
NPI:1922052828
Name:WATKINS, BRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:WATKINS
Suffix:
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 1:1231 116TH AVE NE STE 535
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3804
Mailing Address - Country:US
Mailing Address - Phone:425-668-1916
Mailing Address - Fax:425-688-1901
Practice Address - Street 1:7798 UNIVERSITY CT
Practice Address - Street 2:STE E
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7745
Practice Address - Country:US
Practice Address - Phone:513-939-2263
Practice Address - Fax:513-874-4569
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-067327208600000X
WAMD00036873208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF78621Medicare UPIN