Basic Information
| Provider Information | |||||||||
| NPI: | 1679527527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATKINS | ||||||||
| FirstName: | W | ||||||||
| MiddleName: | MACKEY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5012 S US HWY 75, SUITE 300 | ||||||||
| Address2: | ATTN BILLING | ||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750204589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034166010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5012 S US HIGHWAY 75 | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750204587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034166010 | ||||||||
| FaxNumber: | 9034166183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 12/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | D9710 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | D9710 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100153440A | 05 | OK | MEDICAID | 098998003 | 05 | TX | MEDICAID |