Provider Demographics
NPI:1336193143
Name:HAWKINS, BRADLEY BRAIN (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:BRAIN
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 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-5205
Mailing Address - Fax:850-416-5204
Practice Address - Street 1:4435 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-2066
Practice Address - Country:US
Practice Address - Phone:850-416-5205
Practice Address - Fax:850-416-5204
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263638700Medicaid
FL263638700Medicaid
FLH31487Medicare UPIN