Provider Demographics
NPI:1295744993
Name:WATKINS, NEIL LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:LAWRENCE
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-0366
Mailing Address - Country:US
Mailing Address - Phone:219-885-0116
Mailing Address - Fax:219-881-0522
Practice Address - Street 1:650 GRANT ST
Practice Address - Street 2:SUITE 7
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-1533
Practice Address - Country:US
Practice Address - Phone:219-885-0116
Practice Address - Fax:219-881-0522
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039743A207W00000X
IL036086767207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN180041574OtherRAILROAD MEDICARE
IL036086767Medicaid
IN100147800AMedicaid
IN000000219285OtherANTHEM - BCBS
IN405020Medicare PIN
IN000000219285OtherANTHEM - BCBS
IL036086767Medicaid
IL329120Medicare PIN