MEDICARE: MR. GARY LINDLEY HAWKINS II P.A.-C

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	363AM0700X	Medical Physician Assistant	PA03518	TX

General Provider Information

NPI Number	:	1992731079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY LINDLEY HAWKINS II P.A.-C

Provider Business Mailing Address
First Line	:	505 SPRING CREEK PKWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-7350
Country	:	US
Telephone Number	:	682-351-7765
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 EAST 1-20 SERVICE ROAD SOUTH
Second Line	:	SUITE 100
City	:	ALEDO
State	:	TX
Zip	:	76008-5115
Country	:	US
Telephone Number	:	817-489-7300
Fax Number	:	817-489-7301

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	02/04/2015

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