Healthcare Provider Details

I. General information

NPI: 1053424895
Provider Name (Legal Business Name): CATHERINE GRACE HAWTHORNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S STRONG DR
GALLUP NM
87301
US

IV. Provider business mailing address

305 S STRONG DR
GALLUP NM
87301-6162
US

V. Phone/Fax

Practice location:
  • Phone: 505-726-8015
  • Fax:
Mailing address:
  • Phone: 505-726-8015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD8043
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number83-49
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG86219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: