Healthcare Provider Details

I. General information

NPI: 1144897828
Provider Name (Legal Business Name): ERIC THOMAS HAWLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WUSM PEDS, 1 CHILDRENS PL CB 8116
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

WUSM PEDS, 1 CHILDRENS PL CB 8116
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6018
  • Fax: 844-621-4392
Mailing address:
  • Phone: 314-454-6018
  • Fax: 844-621-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023017554
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: