Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | H8675 | TX |
NPI | 1164489324 |
---|---|
Provider Name | Jeffrey Thomas Hamm |
First Address | Richardson, TX 75080-3595 |
Second Address | Richardson, TX 75080-3595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 14/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E38616 | (02) | TX |