Individual
DR. TRAVIS TYLER HAWKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1307 S MAIN ST, LOCKWOOD, MO 65682-8327
(417) 232-4560
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 820-2000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
060849
GA
207Q00000X
Family Medicine Physician
Primary
2014005002
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MO
Enumeration date
05/12/2008
Last updated
08/06/2014
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