Healthcare Provider Details

I. General information

NPI: 1326097858
Provider Name (Legal Business Name): DEAN D WATKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIRCLE CENTRACARE HEALTH PLAZA
SAINT CLOUD MN
56303-1900
US

IV. Provider business mailing address

1406 6TH AVE N
SAINT CLOUD MN
56303-1900
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4977
  • Fax: 320-656-7058
Mailing address:
  • Phone: 320-251-2700
  • Fax: 320-656-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37265
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: