Provider Demographics
NPI:1659331619
Name:HAWTHORNE, KENNETH BROOKFIELD JR (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:BROOKFIELD
Last Name:HAWTHORNE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N OLD KINGS RD
Mailing Address - Street 2:STE E
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-671-0115
Mailing Address - Fax:
Practice Address - Street 1:106 N OLD KINGS RD
Practice Address - Street 2:STE E
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-671-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMEOO63107207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery