Healthcare Provider Details

I. General information

NPI: 1033047741
Provider Name (Legal Business Name): HENRY DAVID HAWKING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 ABERNETHY RD
OREGON CITY OR
97045-1175
US

IV. Provider business mailing address

6124 SE 41ST AVE
PORTLAND OR
97202-7626
US

V. Phone/Fax

Practice location:
  • Phone: 971-334-9380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: