Provider Demographics
NPI:1881755338
Name:HAWK, JEFFREY RONALD (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RONALD
Last Name:HAWK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1448 10TH AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3579
Mailing Address - Country:US
Mailing Address - Phone:304-691-6381
Mailing Address - Fax:304-691-8591
Practice Address - Street 1:67 HEREFORD LANE
Practice Address - Street 2:
Practice Address - City:APPLE GROVE
Practice Address - State:WV
Practice Address - Zip Code:25502-9403
Practice Address - Country:US
Practice Address - Phone:304-733-8750
Practice Address - Fax:304-908-6042
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV4302207Q00000X
PAOS015626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02612392Medicaid