Provider Demographics
NPI:1942521109
Name:HAWS, LUKE N/A (DO)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:N/A
Last Name:HAWS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:LUKE
Other - Middle Name:N/A
Other - Last Name:HAWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1001 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4948
Mailing Address - Country:US
Mailing Address - Phone:907-459-3500
Mailing Address - Fax:907-459-3526
Practice Address - Street 1:2985 CORTEZ AVE STE 200
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7554
Practice Address - Country:US
Practice Address - Phone:208-535-4300
Practice Address - Fax:208-535-4315
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101119207Q00000X
IDO-0958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1630783Medicaid
AK1630783Medicaid