Healthcare Provider Details

I. General information

NPI: 1447431275
Provider Name (Legal Business Name): JEREMIAH RAY WATKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 DATAPOINT DR
SAN ANTONIO TX
78229-2028
US

IV. Provider business mailing address

9600 DATAPOINT DR
SAN ANTONIO TX
78229-2028
US

V. Phone/Fax

Practice location:
  • Phone: 210-892-3700
  • Fax: 210-617-4692
Mailing address:
  • Phone: 210-892-3720
  • Fax: 210-617-4692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number059231
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number59231
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: