=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538187257
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM GABRIEL HAWKINS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 11/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4921 PARKVIEW PL DIV SURG HPB, STE 12C
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63110-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-747-0410
-----------------------------------------------------
Fax | 877-991-8954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 660 S EUCLID AVE MSC 8109-05-05
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63110-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-747-0410
-----------------------------------------------------
Fax | 877-991-8954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 2004005490
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------