Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 48738-020 | WI |
N | 208600000X | Surgeon | 48738-020 | WI |
N | 208200000X | Surgeon | 80664388017 | UT |
N | 208600000X | Surgeon | 80664388017 | UT |
N | 2086S0105X | Surgery of the Hand | 8873 | SD |
Y | 2086S0105X | Surgery of the Hand | M-13763 | ID |
NPI | 1326240425 |
---|---|
Provider Name | Bruce James Watkins |
First Address | Idaho Falls, ID 83404-7532 |
Second Address | Idaho Falls, ID 83404-7532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 31/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1326240425 | (05) | IA |
1326240425 | (05) | ID |
1326240425 | (05) | NE |
1326240425 | (05) | SD |