Provider Demographics
NPI:1265409759
Name:WATKINS, CAROL D (DO)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:D
Last Name:WATKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:DIANE
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3104 E CAMELBACK RD
Mailing Address - Street 2:STE 384
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016
Mailing Address - Country:US
Mailing Address - Phone:623-748-3302
Mailing Address - Fax:
Practice Address - Street 1:1201 S 7TH AVENUE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007
Practice Address - Country:US
Practice Address - Phone:602-258-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3723207P00000X
TXL7921207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33373558Medicaid
TX191012703Medicaid
AZAW1436OtherHEALTHNET GROUP
AZ765886Medicaid
AZAZ0728670OtherBCBS GROUP
AZ3981220OtherEVERCARE GROUP
AZ453051001OtherGROUP HEALTH GROUP
AZ860373636OtherHUMANA GROUP
AZ3981220OtherEVERCARE GROUP
TXB114633Medicare PIN
TXTXB114633Medicare PIN