Provider Demographics
NPI:1013013002
Name:STOCKDALE PODIATRY GROUP INC
Entity Type:Organization
Organization Name:STOCKDALE PODIATRY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:661-832-1666
Mailing Address - Street 1:110 NEW STINE RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2605
Mailing Address - Country:US
Mailing Address - Phone:661-832-1666
Mailing Address - Fax:661-832-2039
Practice Address - Street 1:110 NEW STINE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2605
Practice Address - Country:US
Practice Address - Phone:661-832-1666
Practice Address - Fax:661-832-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4648OtherLIC # HAWKINS
CAA76044OtherLIC-MIHALUTA
CAE3008OtherLIC-DR.HAMILTON
CAE3891OtherLIC-DR.PASABOC
CAE3301OtherLIC-DR.MILLER
CAE3008OtherLIC-DR.HAMILTON
CAE3891OtherLIC-DR.PASABOC
CAAM3224324OtherDEA- DR. MILLER
CABP3797315OtherDEA- DR. PASABOC
CAE3301OtherLIC-DR.MILLER
CAAM3224324OtherDEA- DR. MILLER
CAT11549Medicare UPIN
CA1091730001Medicare NSC
CAI19359Medicare UPIN
CAT11621Medicare UPIN
CABM7683445OtherDEA-MIHALUTA
CAV08282Medicare UPIN