Healthcare Provider Details

I. General information

NPI: 1720083363
Provider Name (Legal Business Name): JONATHAN L HAWES PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 1ST ST SE
WAUKON IA
52172-2022
US

IV. Provider business mailing address

40 1ST ST SE
WAUKON IA
52172-2022
US

V. Phone/Fax

Practice location:
  • Phone: 563-568-3411
  • Fax: 563-568-6139
Mailing address:
  • Phone: 563-568-3411
  • Fax: 563-568-6139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number710
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: