Individual
LARRY E WATKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 E MAUMEE ST STE 201, ANGOLA, IN 46703-2012
(260) 665-2164
(260) 665-3932
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01025697
IN
207Q00000X
Family Medicine Physician
Primary
01025697
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000088994
ANTHEM ID FOR GEN PRACTIC
IN
01
—
000000226066
ANTHEM ID FOR ANESTHESIA
IN
01
—
000000697433
ANTHEM
IN
05
—
100329360
—
IN
Enumeration date
10/25/2005
Last updated
11/15/2022
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