Organization
JAACA MEDICAL
Active
Other names
SANFORD WATKINS, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANFORD WATKINS (OWNER)
(903) 521-9861
Entity
Organization
Contact information
Practice address
9334 CHISHOLM TRL, TYLER, TX 75703-0407
(903) 521-9861
Mailing address
PO BOX 6008, TYLER, TX 75711-6008
(903) 521-9861
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M3109
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992781090
INDIVIDUAL NPI
TX
Enumeration date
08/16/2012
Last updated
08/16/2012
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