Healthcare Provider Details

I. General information

NPI: 1932186566
Provider Name (Legal Business Name): DR. JEFFREY WILLIAM WATKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 OGDEN AVE
AURORA IL
60504-7597
US

IV. Provider business mailing address

2111 OGDEN AVE
AURORA IL
60504-7597
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-3800
  • Fax: 630-862-3086
Mailing address:
  • Phone: 630-978-3800
  • Fax: 630-862-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016004906
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number016004906
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: