Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | C5106 | AR |
NPI | 1033295878 |
---|---|
Provider Name | Dr. Charles J Watkins |
First Address | Little Rock, AR 72205-5414 |
Second Address | Little Rock, AR 72205-5412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 25/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105022001 | (05) | AR |
D17157 | (02) | AR |