Provider Demographics
NPI:1457535114
Name:HAWKES, CODY J (DO)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:J
Last Name:HAWKES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2086 N 1700 W
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1132
Mailing Address - Country:US
Mailing Address - Phone:801-773-8644
Mailing Address - Fax:801-773-9828
Practice Address - Street 1:1792 W 1700 S
Practice Address - Street 2:SUITE 108
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9650
Practice Address - Country:US
Practice Address - Phone:801-773-8644
Practice Address - Fax:801-776-9828
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR1069208000000X
UT7696028-1204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR1069OtherTRAINING PERMIT