Healthcare Provider Details

I. General information

NPI: 1538160353
Provider Name (Legal Business Name): ELIZABETH KILGOUR HAWKES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 EL CENTRO FAMILIAR BLVD SW
ALBUQUERQUE NM
87105-4592
US

IV. Provider business mailing address

7015 BORG RD NE
ALBUQUERQUE NM
87111-5883
US

V. Phone/Fax

Practice location:
  • Phone: 505-873-7400
  • Fax:
Mailing address:
  • Phone: 505-298-1456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG85127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: