Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 015566 | LA |
NPI | 1134182223 |
---|---|
Provider Name | David P. Hamm |
First Address | Shreveport, LA 71103-3920 |
Second Address | Shreveport, LA 71103-3920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 19/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1658791 | (05) | LA |
E18269 | (02) |