Provider Demographics
NPI:1275742223
Name:HAWS, TERRILL K (DO)
Entity Type:Individual
Prefix:DR
First Name:TERRILL
Middle Name:K
Last Name:HAWS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34110 SELVA RD UNIT 322
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3769
Mailing Address - Country:US
Mailing Address - Phone:847-691-2436
Mailing Address - Fax:
Practice Address - Street 1:34110 SELVA RD UNIT 322
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3769
Practice Address - Country:US
Practice Address - Phone:847-691-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073100208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C42679Medicare UPIN
788850Medicare ID - Type Unspecified