=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174532154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN EUGENE HAWK M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 US HIGHWAY 441 BUILDING 100
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34748-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-460-4004
-----------------------------------------------------
Fax | 352-460-4003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10250 SE 167TH PLACE RD UNIT 5
-----------------------------------------------------
City | SUMMERFIELD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34491-8682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-307-9925
-----------------------------------------------------
Fax | 352-307-8442
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME37647
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------