Provider Demographics
NPI:1356631873
Name:HAWKES, JASON EZRA (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:EZRA
Last Name:HAWKES
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 HOOT OWL LOOP
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5698
Mailing Address - Country:US
Mailing Address - Phone:801-792-5468
Mailing Address - Fax:
Practice Address - Street 1:550 W RANCH VIEW DR STE 2005
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5397
Practice Address - Country:US
Practice Address - Phone:916-295-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA162994207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology