Individual
JEREMIAH RAY WATKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9600 DATAPOINT DR, SAN ANTONIO, TX 78229-2028
(210) 892-3700
(210) 617-4692
Mailing address
9600 DATAPOINT DR, SAN ANTONIO, TX 78229-2028
(210) 892-3720
(210) 617-4692
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
59231
GA
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
059231
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003126490C
—
GA
05
—
003126490D
—
GA
01
—
059231
STATE LICENCSE
GA
01
—
11016
MED DIRECTOR LIC
GA
01
—
160548
STATE MED LIC
FL
01
—
2022-03227
STATE MED LIC
NC
01
—
89012
STATE MED LIC
SC
01
—
V0576
STATE MED LIC
TX
Enumeration date
11/20/2007
Last updated
04/23/2024
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