Healthcare Provider Details

I. General information

NPI: 1457339079
Provider Name (Legal Business Name): JOHN J WATKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9576 HWY 70
MINOCQUA WI
54548-9067
US

IV. Provider business mailing address

9576 HWY 70
MINOCQUA WI
54548-9067
US

V. Phone/Fax

Practice location:
  • Phone: 715-358-1000
  • Fax:
Mailing address:
  • Phone: 715-358-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number56055
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number51822
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: