Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E4648 | UT |
NPI | 1073587663 |
---|---|
Provider Name | Dr. Brandon James Hawkins |
First Address | Bakersfield, CA 93309-2605 |
Second Address | Bakersfield, CA 93309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 18/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BH9505198 | DEA (01) | DC |
E4648 | LIC: (01) | CA |
V08282 | (02) | CA |