Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | E2493 | AR |
N | 207QA0401X | Family Doctor - Addiction Medicine | E2493 | AR |
NPI | 1326028440 |
---|---|
Provider Name | Dr. James M Hawk |
First Address | Harrison, AR 72602-0392 |
Second Address | Harrison, AR 72601-5839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 24/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136552001 | (05) | AR |
149957002 | (05) | AR |
F83562 | (02) | AR |