Provider Demographics
NPI:1225771348
Name:HAWKINS, RYAN (MD, BA)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MD, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3895 STATE LINE RD UNIT 219
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3852
Mailing Address - Country:US
Mailing Address - Phone:417-844-8899
Mailing Address - Fax:
Practice Address - Street 1:1400 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4110
Practice Address - Country:US
Practice Address - Phone:817-922-4529
Practice Address - Fax:817-922-4553
Is Sole Proprietor?:No
Enumeration Date:2022-04-16
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1669472387207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine