Provider Demographics
NPI:1811074008
Name:WATKINS, HARLAN BURNETT JR (MD)
Entity type:Individual
Prefix:MR
First Name:HARLAN
Middle Name:BURNETT
Last Name:WATKINS
Suffix:JR
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 1:909 HYDE ST.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:415-474-7900
Mailing Address - Fax:415-563-5561
Practice Address - Street 1:909 HYDE ST.
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-474-7900
Practice Address - Fax:415-563-5561
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21261207R00000X, 207RC0000X
CAA-21261207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060012213OtherMEDICARE RR
CA00A212610Medicaid
CY0128OtherMEDICARE RR
A22542Medicare UPIN
060012213OtherMEDICARE RR