=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437155835
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAWRENCE R HAWKINS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2005
-----------------------------------------------------
Last Update Date | 10/31/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1277 WOODWARD CANYON RD
-----------------------------------------------------
City | TOUCHET
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99360-9709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-529-1284
-----------------------------------------------------
Fax | 509-522-1798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1663
-----------------------------------------------------
City | WALLA WALLA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99362-0031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-529-1284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | MD00013843
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------