Provider Demographics
NPI:1730186172
Name:HAWNER, PHILIP P (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:P
Last Name:HAWNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 HOLLYBROOK DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2410
Mailing Address - Country:US
Mailing Address - Phone:903-230-3223
Mailing Address - Fax:903-753-7420
Practice Address - Street 1:707 HOLLYBROOK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2410
Practice Address - Country:US
Practice Address - Phone:903-230-3223
Practice Address - Fax:903-753-7420
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK3229208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045323501Medicaid
TX86Y712Medicare PIN
TX045323501Medicaid