MEDICARE: DR. JEFFREY ROBERT WATKINS M.D.

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	208600000X	Surgery Physician	MD60631157	WA
2	208600000X	Surgery Physician	BP10040007	TX
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD60631157	WA
4	208600000X	Surgery Physician	MD184094	OR

General Provider Information

NPI Number	:	1720373509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY ROBERT WATKINS M.D.

Provider Business Mailing Address
First Line	:	1040 NW 22ND AVE STE 470
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-3062
Country	:	US
Telephone Number	:	503-914-0024
Fax Number	:	503-914-0025

Provider Business Practice Location Address
First Line	:	505 NE 87TH AVE STE 301
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1965
Country	:	US
Telephone Number	:	360-514-7374
Fax Number	:	360-514-7384

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

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	01/05/2026

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