Provider Demographics
NPI:1851367718
Name:WATKINS, JOHN V (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:WATKINS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4454 N DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-5286
Mailing Address - Country:US
Mailing Address - Phone:702-839-1203
Mailing Address - Fax:702-839-1301
Practice Address - Street 1:7800 CONSTITUTION AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7552
Practice Address - Country:US
Practice Address - Phone:702-839-1203
Practice Address - Fax:702-839-1301
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67480207LP2900X, 208600000X, 208VP0000X
NMMD2018-0581208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42475813Medicaid
CAF12080Medicare UPIN
CAW17089Medicare ID - Type Unspecified