Individual
MARK G WATKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5701 SWAN CREEK DR, TOLEDO, OH 43614-1104
(419) 490-6448
Mailing address
5701 SWAN CREEK DR, TOLEDO, OH 43614-1104
(419) 490-6448
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
5101016254
MI
2080P0205X
Pediatric Endocrinology Physician
34-009077
OH
208D00000X
General Practice Physician
34.009077
OH
390200000X
Student in an Organized Health Care Education/Training Program
5101016254
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000547496
ANTHEM
OH
01
—
06807
PARAMOUNT
OH
05
—
1770617029
—
MI
05
—
2801187
—
OH
01
—
9666061
AETNA
OH
Enumeration date
03/16/2007
Last updated
06/02/2021
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