Individual
MARK G WATKINS
Active
Individual
MARK G WATKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
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
Update your record
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