Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6068 | LA |
Y | 213EG0000X | General Practice | 6068 | LA |
NPI | 1003128539 |
---|---|
Provider Name | Tony Hammack |
First Address | Slidell, LA 70458-2013 |
Second Address | Slidell, LA 70458-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2010 |
Last Update Date | 13/07/2010 |