Healthcare Provider Details

I. General information

NPI: 1689090060
Provider Name (Legal Business Name): JUSTEN WATKINS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E 400 N # 332
LOGAN UT
84321-4020
US

IV. Provider business mailing address

41 E 400 N # 332
LOGAN UT
84321-4020
US

V. Phone/Fax

Practice location:
  • Phone: 435-640-6290
  • Fax:
Mailing address:
  • Phone: 435-640-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number02008598A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOP61562134
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberV1915
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number007214
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberO-2007
License Number StateID
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0073339
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A13585
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO221295
License Number StateOR
# 9
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO2475
License Number StateNV
# 10
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number11532150-1204
License Number StateUT
# 11
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS23115
License Number StateFL
# 12
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number05-45247
License Number StateKS
# 13
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2024017172
License Number StateMO
# 14
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34.018173
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: