Healthcare Provider Details

I. General information

NPI: 1336188903
Provider Name (Legal Business Name): STEPHEN L HAWKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NORTH MAIN STREET
CABOOL MO
65689
US

IV. Provider business mailing address

PO BOX 69
CABOOL MO
65689-0069
US

V. Phone/Fax

Practice location:
  • Phone: 417-962-3121
  • Fax: 417-962-5240
Mailing address:
  • Phone: 417-962-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR1H82
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: