Healthcare Provider Details

I. General information

NPI: 1386218055
Provider Name (Legal Business Name): THOMAS WATKINS, DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 OAKRIDGE RD
MUSKEGON MI
49441-4023
US

IV. Provider business mailing address

855 OAKRIDGE RD
MUSKEGON MI
49441-4023
US

V. Phone/Fax

Practice location:
  • Phone: 231-755-6038
  • Fax: 231-747-9645
Mailing address:
  • Phone: 231-755-6038
  • Fax: 231-747-9645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOY EARNEST
Title or Position: MANAGER
Credential:
Phone: 231-755-6038