Provider Demographics
NPI:1407466907
Name:HAWK, JOHN LOUIS (RRT, RCP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LOUIS
Last Name:HAWK
Suffix:
Gender:M
Credentials:RRT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W 13TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3136
Mailing Address - Country:US
Mailing Address - Phone:512-367-9313
Mailing Address - Fax:
Practice Address - Street 1:3451 S MERCY RD STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0206
Practice Address - Country:US
Practice Address - Phone:480-719-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRCP4186227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered