Provider Demographics
NPI:1912925207
Name:HAWKINS, RICHARD SCOTT (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:SCOTT
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 1:1901 S UNION AVE STE B7005
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1807
Mailing Address - Country:US
Mailing Address - Phone:253-459-6550
Mailing Address - Fax:253-459-6556
Practice Address - Street 1:1901 S UNION AVE STE B7005
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1807
Practice Address - Country:US
Practice Address - Phone:253-459-6550
Practice Address - Fax:253-459-6556
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013862207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA13862OtherSTATE LICENSE
WAAH6059338OtherDEA NUMBER
WAA08435Medicare UPIN
WA001000469Medicare ID - Type Unspecified
WA1357102Medicaid