Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 4301090553 | MI |
NPI | 1114159415 |
---|---|
Provider Name | Daniel Joseph Watkins |
First Address | Grand Rapids, MI 49503-2556 |
Second Address | Grand Rapids, MI 49503-2556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 13/08/2019 |