Provider Demographics
NPI:1952680464
Name:HAWKINS FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:HAWKINS FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-547-4440
Mailing Address - Street 1:3120 SOUTHRIDE LN
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-3325
Mailing Address - Country:US
Mailing Address - Phone:850-547-4440
Mailing Address - Fax:850-547-4441
Practice Address - Street 1:3120 SOUTHRIDE LN
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-3325
Practice Address - Country:US
Practice Address - Phone:850-547-4440
Practice Address - Fax:850-547-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003587000Medicaid
FLFH130AMedicare PIN