MEDICARE: DR. THOMAS PARKER HAWK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	E4394	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2316710	OTHER	TX	BLUE LINK
2	DW54	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1104823442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS PARKER HAWK M.D.

Provider Business Mailing Address
First Line	:	6131 LUTHER LN
Second Line	:	STE 216
City	:	DALLAS
State	:	TX
Zip	:	75225-6223
Country	:	US
Telephone Number	:	214-987-2020
Fax Number	:	214-739-3725

Provider Business Practice Location Address
First Line	:	6131 LUTHER LN
Second Line	:	STE 216
City	:	DALLAS
State	:	TX
Zip	:	75225-6223
Country	:	US
Telephone Number	:	214-987-2020
Fax Number	:	214-739-3725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/08/2007

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