Provider Demographics
NPI:1083716344
Name:HAWKINS, HARRY L JR (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:L
Last Name:HAWKINS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4125
Mailing Address - Country:US
Mailing Address - Phone:318-219-9911
Mailing Address - Fax:318-219-9911
Practice Address - Street 1:253 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4125
Practice Address - Country:US
Practice Address - Phone:318-219-9911
Practice Address - Fax:318-219-9911
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27932207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNBO2411Medicare UPIN