Provider Demographics
NPI:1407906845
Name:HAWKINS, JOHN RUSSELL IV (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RUSSELL
Last Name:HAWKINS
Suffix:IV
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4702
Mailing Address - Country:US
Mailing Address - Phone:914-502-1425
Mailing Address - Fax:
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4702
Practice Address - Country:US
Practice Address - Phone:914-502-1425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO1000054213E00000X
NYN006188213ES0103X
MD01447213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist