Healthcare Provider Details

I. General information

NPI: 1306372909
Provider Name (Legal Business Name): JUSTIN WATKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 05/12/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E WARNER RD
GILBERT AZ
85296-3082
US

IV. Provider business mailing address

155 E WARNER RD
GILBERT AZ
85296-3082
US

V. Phone/Fax

Practice location:
  • Phone: 480-649-6600
  • Fax: 480-649-6700
Mailing address:
  • Phone: 480-649-6600
  • Fax: 480-649-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28508
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number66347
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: