Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 13201 | MO |
NPI | 1417007600 |
---|---|
Provider Name | Robert E. Hawkins |
First Address | Saint Peters, MO 63376-6438 |
Second Address | Saint Peters, MO 63376-6438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |