Healthcare Provider Details

I. General information

NPI: 1659396695
Provider Name (Legal Business Name): JOSEPH R WATKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 W BAXTER DR STE 120
SOUTH JORDAN UT
84095-5876
US

IV. Provider business mailing address

912 W BAXTER DR STE 120
SOUTH JORDAN UT
84095-5876
US

V. Phone/Fax

Practice location:
  • Phone: 801-666-7220
  • Fax: 801-432-8466
Mailing address:
  • Phone: 801-666-7220
  • Fax: 801-432-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number1706651205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: