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General NPI Number Information
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NPI Number | 1285080796
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Entity Type | Individual
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Provider Name | HAWKINS BOONE MECHAM D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 2162 S 180 E # 1000
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City | PROVO
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State | UT
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Zip | 84606-7370
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Country | US
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Telephone | 385-380-3425
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Fax |
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Provider Business Mailing Address
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Address Line | 2162 S 180 E STE 1000
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City | PROVO
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State | UT
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Zip | 84606-7370
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Country | US
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Telephone | 385-380-3425
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Fax | 855-873-2517
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 110996711204
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | DO187716
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 11099671-1204
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License Number State | UT
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