Provider Demographics
NPI:1992795652
Name:WATKINS, DOUGLAS J (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 OAKDALE AVENUE NO
Mailing Address - Street 2:#315 NORTH CLINIC PA
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2948
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:763-587-7989
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4917
Practice Address - Fax:320-229-5181
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31999207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0707716OtherMEDICA HEALTH PLANS
COMPOtherCHAMPUS
2114087OtherFIRST HEALTH PLAN
761592200OtherMEDICAL ASSISTANCE (MA)
HP22747OtherHEALTH PARTNERS
COMPOtherONE HEALTH PLAN/GREAT WST
110935OtherU-CARE
601023OtherARAZ GROUP/AMERICAS PPO
COMPOtherMMSI
080073015OtherRAILROAD MEDICARE
86D81WAOtherBLUE CROSS BLUE SHIELD
438598OtherPREFERRED ONE
MN761592200Medicaid
MN761592200Medicaid
COMPOtherCHAMPUS
MN080010838Medicare PIN