Healthcare Provider Details

I. General information

NPI: 1912971565
Provider Name (Legal Business Name): JOHN A HAWKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 CHARLTON CT
GOSHEN IN
46526-6463
US

IV. Provider business mailing address

1808 CHARLTON CT
GOSHEN IN
46526-6463
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-3177
  • Fax: 574-533-0758
Mailing address:
  • Phone: 574-534-3177
  • Fax: 574-533-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01032684A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: