Provider Demographics
NPI:1295170645
Name:WATKIN, GEORGE STANLEY
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:STANLEY
Last Name:WATKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:
Other - Last Name:WATKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5074 TERO
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-1824
Mailing Address - Country:US
Mailing Address - Phone:970-948-3506
Mailing Address - Fax:
Practice Address - Street 1:1835 W REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3118
Practice Address - Country:US
Practice Address - Phone:909-890-9054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48537174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist