Provider Demographics
NPI:1588664478
Name:HAWKINS, ALBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:W
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 E CYPRESS ST
Mailing Address - Street 2:G1
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4728
Mailing Address - Country:US
Mailing Address - Phone:805-928-0997
Mailing Address - Fax:805-928-1147
Practice Address - Street 1:1300 E CYPRESS ST
Practice Address - Street 2:G1
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4728
Practice Address - Country:US
Practice Address - Phone:805-928-0997
Practice Address - Fax:805-928-1147
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C413680Medicaid
CAC41368Medicare ID - Type Unspecified
CA00C413680Medicaid