Healthcare Provider Details

I. General information

NPI: 1790725711
Provider Name (Legal Business Name): GREGORY TODD HAMMONS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27015 JESS MORGAN RD
ROLAND AR
72135-9016
US

IV. Provider business mailing address

27015 JESS MORGAN RD
ROLAND AR
72135-9016
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-2650
  • Fax: 501-552-4298
Mailing address:
  • Phone: 501-552-2650
  • Fax: 501-552-4298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number100875
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2005035772
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-6704
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101013518
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: