MEDICARE: DR. DAVE LYNN HAMMONS I ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT-333	ID

General Provider Information

NPI Number	:	1285607598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVE LYNN HAMMONS I ATC

Provider Business Mailing Address
First Line	:	5412 N ISLA AVE
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5852
Country	:	US
Telephone Number	:	208-870-0921
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 UNIVERSITY DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83725-1710
Country	:	US
Telephone Number	:	208-426-4863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	12/05/2025

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