Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A10808 | CA |
N | 207Q00000X | Family Doctor | 20A10808 | CA |
NPI | 1114117223 |
---|---|
Provider Name | Dr. Bryan F Hawkins |
First Address | Oceanside, CA 92054 |
Second Address | Oceanside, CA 92054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2007 |
Last Update Date | 02/04/2010 |