Basic Information
Provider Information | |||||||||
NPI: | 1003860636 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HAWKINS | ||||||||
FirstName: | FRANK | ||||||||
MiddleName: | EDWARD | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4150 KIMBALL AVE | ||||||||
Address2: | PO BOX 2758 | ||||||||
City: | WATERLOO | ||||||||
State: | IA | ||||||||
PostalCode: | 507019086 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3192355390 | ||||||||
FaxNumber: | 3192331630 | ||||||||
Practice Location | |||||||||
Address1: | 3254 KIMBALL AVE | ||||||||
Address2: |   | ||||||||
City: | WATERLOO | ||||||||
State: | IA | ||||||||
PostalCode: | 507025739 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3192357246 | ||||||||
FaxNumber: | 3192353017 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/19/2006 | ||||||||
LastUpdateDate: | 01/06/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35492 | IA | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 208VP0014X | 35492 | IA | Y |   | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208VP0000X | 35492 | IA | N |   | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
ID | Type | State | Issuer | Description | 13811 | 01 | IA | WELLMARK HEALTH PLAN | OTHER | 421417307 J3 | 01 | IA | JOHN DEERE HEALTH PLAN | OTHER | 4554295 | 05 | IA |   | MEDICAID |