Healthcare Provider Details

I. General information

NPI: 1669678660
Provider Name (Legal Business Name): ROBERT WATKINS EMERGENCY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54-383 HOSPITAL ROAD
KAPAAU HI
96755
US

IV. Provider business mailing address

PO BOX 63
HAWI HI
96719-0063
US

V. Phone/Fax

Practice location:
  • Phone: 808-889-6211
  • Fax:
Mailing address:
  • Phone: 808-889-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD 3281
License Number StateHI

VIII. Authorized Official

Name: DR. ROBERT R WATKINS
Title or Position: CEO
Credential: M.D.
Phone: 808-889-6336