Basic Information
| Provider Information | |||||||||
| NPI: | 1366762395 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATKINS | ||||||||
| FirstName: | JAMILA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1847 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852991847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805072961 | ||||||||
| FaxNumber: | 4805072971 | ||||||||
| Practice Location | |||||||||
| Address1: | 428 S GILBERT RD STE 115 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852962262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805072961 | ||||||||
| FaxNumber: | 4805072971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2010 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ML60163188 | WA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 48841 | AZ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 924187 | 05 | AZ | MEDICAID | FW4453192 | 01 | DEA | OTHER |