Healthcare Provider Details

I. General information

NPI: 1720745045
Provider Name (Legal Business Name): SAMUEL DALE HAWKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST
AKRON OH
44304-1619
US

IV. Provider business mailing address

740 HIGHLAND PARK DR
NEW FRANKLIN OH
44319-4758
US

V. Phone/Fax

Practice location:
  • Phone: 330-379-5986
  • Fax:
Mailing address:
  • Phone: 573-814-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number57.258574
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: