MEDICARE: DR. JACK HAWKS DO

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	207Q00000X	Family Medicine Physician	4049	AZ

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	:	1194835660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK HAWKS DO

Provider Business Mailing Address
First Line	:	9191 W. THUNDERBIRD RD.
Second Line	:	SUITE D-105
City	:	PEORIA
State	:	AZ
Zip	:	85381-4816
Country	:	US
Telephone Number	:	623-849-3811
Fax Number	:	623-849-5221

Provider Business Practice Location Address
First Line	:	9191 W. THUNDERBIRD RD.
Second Line	:	SUITE D-105
City	:	PEORIA
State	:	AZ
Zip	:	85381-4816
Country	:	US
Telephone Number	:	623-849-3811
Fax Number	:	623-849-5221

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. JACK HAWKS DO” Practice Location

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