Provider Demographics
NPI:1720093677
Name:HAWKINS, TREVOR (MD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:
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 1:649 HARKLE RD STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4765
Mailing Address - Country:US
Mailing Address - Phone:505-989-8200
Mailing Address - Fax:505-989-8131
Practice Address - Street 1:649 HARKLE RD STE E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4765
Practice Address - Country:US
Practice Address - Phone:505-989-8200
Practice Address - Fax:505-989-8131
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83-212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27110Medicaid
NMPROVP14050OtherMOLINA SALUD
NMNM000390OtherBCBS
NM201004174OtherPHP
NM$$$$$$$$$MMedicare PIN
NMNM000390OtherBCBS