Provider Demographics
NPI:1699774752
Name:WATKINS, RUFUS W (MD)
Entity type:Individual
Prefix:MR
First Name:RUFUS
Middle Name:W
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1012 MEDICAL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-4542
Mailing Address - Country:US
Mailing Address - Phone:864-833-3852
Mailing Address - Fax:864-938-0501
Practice Address - Street 1:1012 MEDICAL RIDGE RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-4542
Practice Address - Country:US
Practice Address - Phone:864-833-3852
Practice Address - Fax:864-938-0501
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC7010208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC070103Medicaid