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NPI Code Detail

MEDICARE: DR. JEREMY HAWKINS PHD, ATC, LAT

MEDICARE: DR. JEREMY HAWKINS PHD, ATC, LAT
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
12255A2300XAthletic TrainerAT.0001223CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122OTHERUTATHLETIC TRAINER

General Provider Information

NPI Number : 1861411415
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMY HAWKINS PHD, ATC, LAT
Provider Business Mailing Address
First Line : 1100 NORTH AVE
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81501-3122
Country : US
Telephone Number : 970-248-1374
Fax Number :
Provider Business Practice Location Address
First Line : 1100 NORTH AVE
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81501-3122
Country : US
Telephone Number : 970-248-1374
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 06/01/2020

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