MEDICARE: DR. BRIAN GHALAMBOR HAWKINS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146D00000X	Personal Emergency Response Attendant	31076	AZ
2	207R00000X	Internal Medicine Physician	31076	AZ

General Provider Information

NPI Number	:	1912999418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN GHALAMBOR HAWKINS M.D.

Provider Business Mailing Address
First Line	:	5220 N. DYSART ROAD
Second Line	:	SUITE 172
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-3005
Country	:	US
Telephone Number	:	623-695-9789
Fax Number	:	800-317-0013

Provider Business Practice Location Address
First Line	:	5220 N DYSART RD
Second Line	:	SUITE 172
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-3045
Country	:	US
Telephone Number	:	623-695-9789
Fax Number	:	800-317-0013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	07/28/2015

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