Provider Demographics
NPI:1336188903
Name:HAWKINS, STEPHEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:HAWKINS
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:CABOOL
Mailing Address - State:MO
Mailing Address - Zip Code:65689-0069
Mailing Address - Country:US
Mailing Address - Phone:417-962-5201
Mailing Address - Fax:
Practice Address - Street 1:500 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CABOOL
Practice Address - State:MO
Practice Address - Zip Code:65689
Practice Address - Country:US
Practice Address - Phone:417-962-3121
Practice Address - Fax:417-962-5240
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1H82207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO597943901OtherRH MEDICAID
MO202499752Medicaid
MO26-8603OtherRH MEDICARE
MO26-8603OtherRH MEDICARE
MO202499752Medicaid
MO000014985Medicare PIN