Healthcare Provider Details

I. General information

NPI: 1457535114
Provider Name (Legal Business Name): CODY J HAWKES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 E 100 S STE 14
SAINT GEORGE UT
84790-3005
US

IV. Provider business mailing address

1240 E 100 S STE 14
ST GEORGE UT
84790-3005
US

V. Phone/Fax

Practice location:
  • Phone: 356-288-2324
  • Fax: 435-674-7994
Mailing address:
  • Phone: 435-628-8232
  • Fax: 435-674-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR1069
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7696028-1204
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierR1069
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerTRAINING PERMIT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: