Provider Demographics
NPI:1396704565
Name:HAWKINS, JEFFREY J (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:73 PASEO DEL PAISANO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-7984
Mailing Address - Country:US
Mailing Address - Phone:505-988-1045
Mailing Address - Fax:888-351-6207
Practice Address - Street 1:73 PASEO DEL PAISANO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-7984
Practice Address - Country:US
Practice Address - Phone:505-988-1045
Practice Address - Fax:888-351-6207
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM93-281208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC35652Medicare UPIN