Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 14714 | KY |
N | 208600000X | Surgeon | 14714 | KY |
N | 2086S0129X | Vascular Surgeon | 14714 | KY |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 14714 | KY |
NPI | 1033215017 |
---|---|
Provider Name | Jack L Hamman |
First Address | Madisonville, KY 42431-1661 |
Second Address | Madisonville, KY 42431-1658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000044325 | BCBS PROVIDER NUMBER (01) | |
14714 | LICENSE (01) | KY |
64147143 | (05) | KY |
C64326 | (02) |