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General NPI Number Information
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NPI Number | 1356631873
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Entity Type | Individual
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Provider Name | JASON EZRA HAWKES MD, MS
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Gender | Male
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 1750 S HARBOR WAY STE 330
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City | PORTLAND
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State | OR
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Zip | 97201-5134
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Country | US
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Telephone | 503-245-1525
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Fax | 503-245-0315
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Provider Business Mailing Address
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Address Line | 1750 S HARBOR WAY STE 330
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City | PORTLAND
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State | OR
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Zip | 97201-5134
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Country | US
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Telephone | 503-245-1525
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Fax | 503-245-0315
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD220929
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License Number State | OR
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