Individual
MICHAEL C HAWKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1660 ANTELOPE DRIVE, STE 225, LAYTON, UT 84041
(801) 479-0312
(801) 479-0312
Mailing address
1660 W ANTELOPE DR STE 225, LAYTON, UT 84041-1167
(801) 479-0312
(801) 479-0312
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
500991-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45974174905001
BCS
—
01
—
870680455
MHB
—
01
—
870680455A014
TRICARE
—
01
—
QM000070485
ALTIUS
—
Enumeration date
08/22/2005
Last updated
11/19/2011
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