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General NPI Number Information
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NPI Number | 1992795652
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Entity Type | Individual
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Provider Name | DOUGLAS J WATKINS M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 1900 CENTRACARE CIR
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City | SAINT CLOUD
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State | MN
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Zip | 56303-5000
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Country | US
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Telephone | 320-229-4917
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Fax | 320-229-5181
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Provider Business Mailing Address
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Address Line | 3366 OAKDALE AVENUE NO #315 NORTH CLINIC PA
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2948
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Country | US
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Telephone | 763-587-7900
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Fax | 763-587-7989
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31999
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 31999
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License Number State | MN
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