Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD12758 | OR |
NPI | 1104809276 |
---|---|
Provider Name | June M. Hawkins |
First Address | Oregon City, OR 97045-7358 |
Second Address | Oregon City, OR 97045-8008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 07/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009196 | (05) | OR |
12758 | OREGON MEDICAL LICENSE (01) | OR |
838724000 | BCBS - GROUP (01) | OR |
838724001 | BCBS - INDIVIDUAL (01) | OR |
AH1102867 | DEA (01) | OR |