Provider Demographics
NPI:1295894269
Name:HANKINS, ROY DEWAYNE (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:DEWAYNE
Last Name:HANKINS
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 1:2558 271 AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MN
Mailing Address - Zip Code:56256
Mailing Address - Country:US
Mailing Address - Phone:320-752-4250
Mailing Address - Fax:320-752-4350
Practice Address - Street 1:2558 271 AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MN
Practice Address - Zip Code:56256
Practice Address - Country:US
Practice Address - Phone:320-752-4250
Practice Address - Fax:320-752-4350
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN250052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
275S8HAOtherBLUE CROSS
1553739OtherUBH
MN083245600Medicaid
1031976OtherPREFERRED ONE
142760OtherUCARE
MN260002048OtherMEDICARE
MN083245600Medicaid