Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 23928 | OK |
N | 111NI0900X | Internist | 23928 | OK |
N | 207RC0000X | Internist - Cardiovascular Disease | 23928 | OK |
Y | 207RI0011X | Interventional Cardiology | 23928 | OK |
NPI | 1073654893 |
---|---|
Provider Name | Dr. Beau Michael Hawkins |
First Address | Boston, MA 02114-2621 |
Second Address | Oklahoma City, OK 73104-5417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 15/05/2017 |