Provider Demographics
NPI:1902803646
Name:HAWKINS, BRIAN L (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 NORTON HEALTHCARE BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2831
Mailing Address - Country:US
Mailing Address - Phone:502-425-5556
Mailing Address - Fax:502-425-5655
Practice Address - Street 1:4950 NORTON HEALTHCARE BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2831
Practice Address - Country:US
Practice Address - Phone:502-425-5556
Practice Address - Fax:502-425-5655
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038764C207Y00000X
KY26782207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY040012433OtherRAIL ROAD MEDICARE
KY000000477283OtherANTHEM PROVIDER ID
IN100347880Medicaid
KY64267826Medicaid
KY00084001Medicare PIN
IN100347880Medicaid