Healthcare Provider Details

I. General information

NPI: 1619950599
Provider Name (Legal Business Name): CURTIS R HAWKINSON PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 SKYLINE VILLAGE LOOPS
SALEM OR
97306-9490
US

IV. Provider business mailing address

5050 SKYLINE VILLAGE LOOPS
SALEM OR
97306-9490
US

V. Phone/Fax

Practice location:
  • Phone: 503-391-1110
  • Fax: 503-370-4237
Mailing address:
  • Phone: 503-391-1110
  • Fax: 503-370-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00365
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: