Healthcare Provider Details

I. General information

NPI: 1720093677
Provider Name (Legal Business Name): TREVOR HAWKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 HARKLE RD STE E
SANTA FE NM
87505-4765
US

IV. Provider business mailing address

649 HARKLE RD STE E
SANTA FE NM
87505-4765
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-8200
  • Fax: 505-989-8131
Mailing address:
  • Phone: 505-989-8200
  • Fax: 505-989-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number83-212
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: