Individual
BERT TRAVIS HAWKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 AUDUBON PLAZA DR, LOUISVILLE, KY 40217-1318
(502) 634-6767
(502) 634-6775
Mailing address
PO BOX 36218, LOUISVILLE, KY 40233-6218
(502) 634-6767
(502) 634-6775
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
41625
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000772946
ANTHEM
KY
05
—
201071110
—
IN
01
—
311192100
BLACK LUNG
KY
01
—
50039550
PASSPORT
KY
05
—
7100031100
—
KY
Enumeration date
04/04/2008
Last updated
08/16/2012
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