Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 11476 | NC |
Y | 213EG0000X | General Practice | 11476 | NC |
NPI | 1003477159 |
---|---|
Provider Name | Dustin John Hamren |
First Address | Hickory, NC 28601-1469 |
Second Address | Hickory, NC 28601-1469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2019 |
Last Update Date | 27/06/2019 |