Provider Demographics
NPI:1629021118
Name:RONNIE HAWKINS FAMILY PRACTICE MEDICAL CLINIC PLC
Entity Type:Organization
Organization Name:RONNIE HAWKINS FAMILY PRACTICE MEDICAL CLINIC PLC
Other - Org Name:DR. HAWKINS OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MAJED
Authorized Official - Middle Name:WALEED
Authorized Official - Last Name:BARAZANJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-440-6622
Mailing Address - Street 1:1701 22ND ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1443
Mailing Address - Country:US
Mailing Address - Phone:515-224-1001
Mailing Address - Fax:515-224-1004
Practice Address - Street 1:1701 22ND ST
Practice Address - Street 2:SUITE 107
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1443
Practice Address - Country:US
Practice Address - Phone:515-224-1001
Practice Address - Fax:515-224-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0281865Medicaid
IAI9095Medicare PIN
IA0281865Medicaid