Individual
DR. HAWKINS BOONE MECHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2162 S 180 E # 1000, PROVO, UT 84606-7370
(385) 380-3425
Mailing address
2162 S 180 E STE 1000, PROVO, UT 84606-7370
(385) 380-3425
(855) 873-2517
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
110996711204
UT
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
11099671-1204
UT
208D00000X
General Practice Physician
DO187716
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110996711204
STATE PROFESSIONAL LICENSE
UT
01
—
110996718904
STATE CONTROLLED SUBSTANCE LICENSE
UT
Enumeration date
05/13/2016
Last updated
03/19/2025
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