MEDICARE: JACOB HAWKINS 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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	ME155488	FL
2	207X00000X	Orthopaedic Surgery Physician	ME155488	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154855500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB HAWKINS M.D.

Provider Business Mailing Address
First Line	:	1034 MAR WALT DR
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6639
Country	:	US
Telephone Number	:	850-863-2153
Fax Number	:

Provider Business Practice Location Address
First Line	:	36474C EMERALD COAST PKWY
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-6700
Country	:	US
Telephone Number	:	850-863-2153
Fax Number	:

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

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	08/02/2023

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