MEDICARE: DOUGLAS J WATKINS M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	31999	MN
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	31999	MN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	080073015	OTHER		RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0707716	OTHER	MEDICA HEALTH PLANS
2	COMP	OTHER	CHAMPUS
3	2114087	OTHER	FIRST HEALTH PLAN
4	761592200	OTHER	MEDICAL ASSISTANCE (MA)
5	HP22747	OTHER	HEALTH PARTNERS
6	COMP	OTHER	ONE HEALTH PLAN/GREAT WST
7	110935	OTHER	U-CARE
8	601023	OTHER	ARAZ GROUP/AMERICAS PPO
9	COMP	OTHER	MMSI
11	86D81WA	OTHER	BLUE CROSS BLUE SHIELD
12	438598	OTHER	PREFERRED ONE
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1992795652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS J WATKINS M.D.

Provider Business Mailing Address
First Line	:	3366 OAKDALE AVENUE NO
Second Line	:	#315 NORTH CLINIC PA
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2948
Country	:	US
Telephone Number	:	763-587-7900
Fax Number	:	763-587-7989

Provider Business Practice Location Address
First Line	:	1900 CENTRACARE CIR
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-5000
Country	:	US
Telephone Number	:	320-229-4917
Fax Number	:	320-229-5181

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	05/26/2010

1900 CENTRACARE CIR , CENTRACARE CLINIC HEALTH PLAZA
SAINT CLOUD, MN
56303-5000

Practice Phone: 320-252-2422
Practice Fax: