Healthcare Provider Details

I. General information

NPI: 1851371876
Provider Name (Legal Business Name): MARVIN A HAMMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S STAPLEY DR
MESA AZ
85204-6681
US

IV. Provider business mailing address

1840 S STAPLEY DR
MESA AZ
85204-6681
US

V. Phone/Fax

Practice location:
  • Phone: 480-464-8500
  • Fax:
Mailing address:
  • Phone: 480-464-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14984
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: