Provider Demographics
NPI:1548292774
Name:HAWKINSON, DORA LYNN (PAC)
Entity type:Individual
Prefix:MRS
First Name:DORA
Middle Name:LYNN
Last Name:HAWKINSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 FM 1959 RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-5416
Mailing Address - Country:US
Mailing Address - Phone:281-481-9400
Mailing Address - Fax:281-481-9490
Practice Address - Street 1:444 FM 1959 RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-5416
Practice Address - Country:US
Practice Address - Phone:281-481-9400
Practice Address - Fax:281-481-9490
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02055363A00000X
TX1036559363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q26551Medicare UPIN