Provider Demographics
NPI:1659334274
Name:HAWK, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:HAWK
Suffix:
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 1:2154 DUCK SLOUGH BLVD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5073
Mailing Address - Country:US
Mailing Address - Phone:727-937-6020
Mailing Address - Fax:866-665-2702
Practice Address - Street 1:2154 DUCK SLOUGH BLVD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5073
Practice Address - Country:US
Practice Address - Phone:727-937-6020
Practice Address - Fax:866-665-2702
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039631207L00000X
FLME110447207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100379620Medicaid
IN342220CMedicare PIN
IN343960Medicare PIN
INE88961Medicare UPIN