Provider Demographics
NPI:1417244591
Name:WATKINS, FRED M (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:M
Last Name:WATKINS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-0390
Mailing Address - Country:US
Mailing Address - Phone:951-200-6919
Mailing Address - Fax:909-321-5080
Practice Address - Street 1:1810 FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3103
Practice Address - Country:US
Practice Address - Phone:951-200-6919
Practice Address - Fax:909-321-5080
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine