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NPI Code Detail

MEDICARE: DR. JEFFERY KARRON HAWKINS M.D.

MEDICARE: DR. JEFFERY KARRON 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
1207QS0010XSports Medicine (Family Medicine) PhysicianQ3197TX
2207Q00000XFamily Medicine PhysicianQ3197TX

General Provider Information

NPI Number : 1609175843
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFERY KARRON HAWKINS M.D.
Provider Business Mailing Address
First Line : 1521 REDSTONE DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-4641
Country : US
Telephone Number : 409-877-4225
Fax Number :
Provider Business Practice Location Address
First Line : 7148 TRAIL LAKE DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76123-1969
Country : US
Telephone Number : 817-294-0934
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2011
Last Update Date : 07/30/2015

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