Provider Demographics
NPI:1285080796
Name:MECHAM, HAWKINS BOONE (DO)
Entity type:Individual
Prefix:DR
First Name:HAWKINS
Middle Name:BOONE
Last Name:MECHAM
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 S 180 E STE 1000
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-7370
Mailing Address - Country:US
Mailing Address - Phone:385-380-3425
Mailing Address - Fax:855-873-2517
Practice Address - Street 1:2162 S 180 E # 1000
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-7370
Practice Address - Country:US
Practice Address - Phone:385-380-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110996711204204C00000X
ORDO187716208D00000X
UT11099671-1204204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT110996711204OtherSTATE PROFESSIONAL LICENSE
UT110996718904OtherSTATE CONTROLLED SUBSTANCE LICENSE