Provider Demographics
NPI:1912999418
Name:HAWKINS, BRIAN GHALAMBOR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:GHALAMBOR
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5220 N. DYSART ROAD
Mailing Address - Street 2:SUITE 172
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3005
Mailing Address - Country:US
Mailing Address - Phone:623-695-9789
Mailing Address - Fax:800-317-0013
Practice Address - Street 1:5220 N DYSART RD
Practice Address - Street 2:SUITE 172
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-3045
Practice Address - Country:US
Practice Address - Phone:623-695-9789
Practice Address - Fax:800-317-0013
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ31076146D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant