Healthcare Provider Details

I. General information

NPI: 1609175843
Provider Name (Legal Business Name): JEFFERY KARRON HAWKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7148 TRAIL LAKE DR
FORT WORTH TX
76123-1969
US

IV. Provider business mailing address

1521 REDSTONE DR
FORT WORTH TX
76112-4641
US

V. Phone/Fax

Practice location:
  • Phone: 817-294-0934
  • Fax:
Mailing address:
  • Phone: 409-877-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberQ3197
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ3197
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: