Provider Demographics
NPI:1831416015
Name:HAWLEY, DUSTIN EUGENE (MD)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:EUGENE
Last Name:HAWLEY
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 1:104 N BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4010
Mailing Address - Country:US
Mailing Address - Phone:806-274-3627
Mailing Address - Fax:
Practice Address - Street 1:104 N BRYAN ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4010
Practice Address - Country:US
Practice Address - Phone:806-274-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine