Provider Demographics
NPI:1982708632
Name:DONALD R. WATKINS
Entity type:Organization
Organization Name:DONALD R. WATKINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASUREY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARYON
Authorized Official - Middle Name:
Authorized Official - Last Name:GATHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-526-9821
Mailing Address - Street 1:4900 FANNIN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006
Mailing Address - Country:US
Mailing Address - Phone:713-526-9821
Mailing Address - Fax:713-528-7285
Practice Address - Street 1:4900 FANNIN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004
Practice Address - Country:US
Practice Address - Phone:713-526-9821
Practice Address - Fax:713-528-7285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9471261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88400KMedicare ID - Type Unspecified
TXC16024Medicare UPIN