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Organization
IDAHO UROLOGY CLINIC, P.A.
Active
Organization
IDAHO UROLOGY CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILFRED E WATKINS M.D. (OWNER)
(208) 466-2461
Entity
Organization
Contact information
Practice address
1613 12TH AVE RD STE B, NAMPA, ID 83686-6183
(208) 466-2461
(208) 466-2488
Mailing address
1613 12TH AVE RD STE B, NAMPA, ID 83686-6183
(208) 466-2461
(208) 466-2488
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M2768
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002409100
—
ID
01
—
1598811945
CORP NPI
ID
Enumeration date
01/26/2007
Last updated
11/09/2010
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