Healthcare Provider Details

I. General information

NPI: 1851367718
Provider Name (Legal Business Name): JOHN V WATKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7552
US

IV. Provider business mailing address

4454 N DECATUR BLVD
LAS VEGAS NV
89130-5286
US

V. Phone/Fax

Practice location:
  • Phone: 702-839-1203
  • Fax: 702-839-1301
Mailing address:
  • Phone: 702-839-1203
  • Fax: 702-839-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG67480
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG67480
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberG67480
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD2018-0581
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD2018-0581
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: