Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 8678 | MN |
Y | 213EG0000X | General Practice | 8678 | MN |
NPI | 1003913278 |
---|---|
Provider Name | Dr. David C Watkins |
First Address | Minneapolis, MN 55440-1309 |
Second Address | St Paul, MN 55106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |