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Organization
HERITAGE FAMILY MEDICINE, LLC
Active
Organization
HERITAGE FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK HAWKINS M.D. (PHYSICIAN)
(850) 547-2209
Entity
Organization
Contact information
Practice address
101 E WISCONSIN AVE, BONIFAY, FL 32425-1809
(850) 547-2209
(850) 547-4521
Mailing address
101 E WISCONSIN AVE, BONIFAY, FL 32425-1809
(850) 547-2209
(850) 547-4521
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME105126
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003587000
—
FL
01
—
18651
MEDICARE PTAN
FL
05
—
372395000
—
FL
01
—
FH128Z
MEDICARE PTAN
FL
Enumeration date
04/24/2013
Last updated
04/24/2013
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