Healthcare Provider Details

I. General information

NPI: 1417206095
Provider Name (Legal Business Name): ROBERT L WATKINS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 09/23/2026
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S. INTERNATIONAL PKWY UNIT 1481
LAKE MARY FL
32746
US

IV. Provider business mailing address

1355 S. INTERNATIONAL PKWY UNIT 1481
LAKE MARY FL
32746
US

V. Phone/Fax

Practice location:
  • Phone: 407-559-7011
  • Fax: 833-455-6836
Mailing address:
  • Phone: 407-559-7011
  • Fax: 833-455-6836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME126649
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: