Provider Demographics
NPI:1427355601
Name:HAWTHORNE, RICHARD DAWSON (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAWSON
Last Name:HAWTHORNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 N W ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-1719
Mailing Address - Country:US
Mailing Address - Phone:850-474-3660
Mailing Address - Fax:850-474-3659
Practice Address - Street 1:6431 N W ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-1719
Practice Address - Country:US
Practice Address - Phone:850-474-3660
Practice Address - Fax:850-474-3659
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine