Provider Demographics
NPI:1669406179
Name:HAWKER, GREGORY P (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
Last Name:HAWKER
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-395-8393
Mailing Address - Fax:740-395-8592
Practice Address - Street 1:500 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9360
Practice Address - Country:US
Practice Address - Phone:740-395-8393
Practice Address - Fax:740-395-8592
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2027069Medicaid
OH4038720OtherAETNA
WV3810014399Medicaid
OH310917085306OtherCARESOURCE
OH000000261559OtherANTHEM (BLUE CROSS)
OHH105400Medicare PIN
A80844Medicare UPIN