Provider Demographics
NPI:1134308448
Name:HAWK, RAYMOND LAWRENCE (PA)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:LAWRENCE
Last Name:HAWK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:RAYMOND
Other - Middle Name:LAWRENCE
Other - Last Name:HAWK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:13071 NETT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORR
Mailing Address - State:MN
Mailing Address - Zip Code:55771-8111
Mailing Address - Country:US
Mailing Address - Phone:218-757-3650
Mailing Address - Fax:218-757-0234
Practice Address - Street 1:13071 NETT LAKE RD
Practice Address - Street 2:
Practice Address - City:ORR
Practice Address - State:MN
Practice Address - Zip Code:55771-8111
Practice Address - Country:US
Practice Address - Phone:218-757-3650
Practice Address - Fax:218-757-0234
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9370363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical