MEDICARE: DR. BRAD WATKINS MD

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	35-067327	OH
2	208600000X	Surgery Physician	MD00036873	WA

General Provider Information

NPI Number	:	1922052828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD WATKINS MD

Provider Business Mailing Address
First Line	:	1231 116TH AVE NE STE 535
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3804
Country	:	US
Telephone Number	:	425-668-1916
Fax Number	:	425-688-1901

Provider Business Practice Location Address
First Line	:	7798 UNIVERSITY CT
Second Line	:	STE E
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-7745
Country	:	US
Telephone Number	:	513-939-2263
Fax Number	:	513-874-4569

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	12/16/2020

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