Healthcare Provider Details

I. General information

NPI: 1770617029
Provider Name (Legal Business Name): MARK G WATKINS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 SWAN CREEK DR
TOLEDO OH
43614-1104
US

IV. Provider business mailing address

5701 SWAN CREEK DR
TOLEDO OH
43614-1104
US

V. Phone/Fax

Practice location:
  • Phone: 419-490-6448
  • Fax:
Mailing address:
  • Phone: 419-490-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number34-009077
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34.009077
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5101016254
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101016254
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: