MEDICARE: DR. CAROL D WATKINS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	3723	AZ
2	207P00000X	Emergency Medicine Physician	L7921	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AW1436	OTHER	AZ	HEALTHNET GROUP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	AZ0728670	OTHER	AZ	BCBS GROUP
6	3981220	OTHER	AZ	EVERCARE GROUP
7	453051001	OTHER	AZ	GROUP HEALTH GROUP
8	860373636	OTHER	AZ	HUMANA GROUP

General Provider Information

NPI Number	:	1265409759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL D WATKINS DO

Provider Business Mailing Address
First Line	:	3104 E CAMELBACK RD
Second Line	:	STE 384
City	:	PHOENIX
State	:	AZ
Zip	:	85016
Country	:	US
Telephone Number	:	623-748-3302
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 S 7TH AVENUE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007
Country	:	US
Telephone Number	:	602-258-5111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	09/08/2011

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