Provider Demographics
NPI:1659452399
Name:HAWLEY, MITCHELL LYNN (DPM)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:LYNN
Last Name:HAWLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 GOODWATER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1514
Mailing Address - Country:US
Mailing Address - Phone:530-224-0990
Mailing Address - Fax:530-224-0940
Practice Address - Street 1:2570 GOODWATER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1514
Practice Address - Country:US
Practice Address - Phone:530-224-0990
Practice Address - Fax:530-224-0940
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3819213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480014139OtherRAILROAD MEDICARE
CAE3819OtherINSURACE COMPANIES
CA000E38190Medicaid
000E38190Medicare ID - Type Unspecified
CAE3819OtherINSURACE COMPANIES