Healthcare Provider Details

I. General information

NPI: 1275581761
Provider Name (Legal Business Name): JOSHUA A. WATKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 2ND ST
BLOOMINGTON IN
47403-2317
US

IV. Provider business mailing address

601 W 2ND ST
BLOOMINGTON IN
47403-2317
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-9147
  • Fax:
Mailing address:
  • Phone: 812-353-9147
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA105101
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA105101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: