Healthcare Provider Details

I. General information

NPI: 1396704565
Provider Name (Legal Business Name): JEFFREY J HAWKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 PASEO DEL PAISANO
SANTA FE NM
87506-7984
US

IV. Provider business mailing address

73 PASEO DEL PAISANO
SANTA FE NM
87506-7984
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-1045
  • Fax: 888-351-6207
Mailing address:
  • Phone: 505-988-1045
  • Fax: 888-351-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number93-281
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: