Individual
GLEN LEE WATKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 CHINABERRY DR STE 1103, BOSSIER CITY, LA 71111-2463
(318) 716-1111
(318) 716-1112
Mailing address
1000 CHINABERRY DR STE 1103, BOSSIER CITY, LA 71111-2463
(318) 716-1111
(318) 716-1112
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
050489
GA
207Y00000X
Otolaryngology Physician
Primary
205062
LA
207Y00000X
Otolaryngology Physician
ME98502
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21744801
—
LA
Enumeration date
06/19/2005
Last updated
12/07/2020
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