Provider Demographics
NPI:1720376569
Name:HAWKES, ROBERT M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:HAWKES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-6636
Mailing Address - Country:US
Mailing Address - Phone:239-274-1024
Mailing Address - Fax:
Practice Address - Street 1:3650 COLONIAL CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-6636
Practice Address - Country:US
Practice Address - Phone:239-274-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105521363A00000X
MEPA001216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant