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General NPI Number Information
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NPI Number | 1982146346
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Entity Type | Organization
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Legal Business Name | WATKINS FOOT AND ANKLE CLINIC LLC
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 914 E DIXIE AVE
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City | LEESBURG
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State | FL
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Zip | 34748-7647
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Country | US
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Telephone | 352-805-4317
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Fax | 352-805-4298
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Provider Business Mailing Address
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Address Line | 914 E DIXIE AVE
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City | LEESBURG
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State | FL
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Zip | 34748-7647
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Country | US
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Telephone | 352-805-4317
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Fax | 352-805-4298
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Authorized Official
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Title or Position | CEO
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Name | DR. CHAD C WATKINS
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Credential | D.P.M.
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Telephone | 352-805-4317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO2769
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License Number State | FL
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