Healthcare Provider Details

I. General information

NPI: 1992731079
Provider Name (Legal Business Name): GARY LINDLEY HAWKINS II P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GARY LINDLEY HAWKINS II P.A.-C

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 EAST 1-20 SERVICE ROAD SOUTH SUITE 100
ALEDO TX
76008-5115
US

IV. Provider business mailing address

505 SPRING CREEK PKWY
WEATHERFORD TX
76087-7350
US

V. Phone/Fax

Practice location:
  • Phone: 817-489-7300
  • Fax: 817-489-7301
Mailing address:
  • Phone: 682-351-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA03518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: