Individual
DERRAL EDWARD HAWTHORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
94180 2ND ST, GOLD BEACH, OR 97444-8733
(541) 247-7047
(541) 247-0123
Mailing address
94180 2ND ST, GOLD BEACH, OR 97444-8733
(541) 247-3940
(541) 247-3116
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA191287
OR
Other
Enumeration date
08/28/2013
Last updated
03/03/2025
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