Healthcare Provider Details

I. General information

NPI: 1326240425
Provider Name (Legal Business Name): BRUCE JAMES WATKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 ELK CREEK DR
IDAHO FALLS ID
83404-8322
US

IV. Provider business mailing address

1542 ELK CREEK DR
IDAHO FALLS ID
83404-8322
US

V. Phone/Fax

Practice location:
  • Phone: 844-919-4263
  • Fax: 833-513-0980
Mailing address:
  • Phone: 844-919-4263
  • Fax: 833-513-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number80664388017
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number48738-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number8873
License Number StateSD
# 4
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberM-13763
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: