Individual
DR. WILFRED E WATKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.S.
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
—
1370335
MEDICARE CLINIC NUMBER
ID
01
—
1598811945
NPI CORPORATION NUMBER
ID
01
—
1710981162
INDIVIDUAL NPI
ID
Enumeration date
06/13/2005
Last updated
10/12/2010
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