Provider Demographics
NPI:1467400226
Name:HAWES, JOHN RAYMOND JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAYMOND
Last Name:HAWES
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:16017 TUSCOLA RD
Mailing Address - Street 2:STE B
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307
Mailing Address - Country:US
Mailing Address - Phone:760-242-2411
Mailing Address - Fax:760-242-5572
Practice Address - Street 1:16017 TUSCOLA RD
Practice Address - Street 2:STE B
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:760-242-2411
Practice Address - Fax:760-242-5572
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-06-24
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Provider Licenses
StateLicense IDTaxonomies
CA20A49860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX49860Medicaid
CA330254776OtherBLUE CROSS BLUE SHIELD
E08854Medicare UPIN
CA330254776OtherBLUE CROSS BLUE SHIELD