Healthcare Provider Details

I. General information

NPI: 1659593739
Provider Name (Legal Business Name): STEPHEN CURTIS HAMMETT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46641 N BLACK CANYON HWY SUITE 5
NEW RIVER AZ
85087-6941
US

IV. Provider business mailing address

7046 W LONE TREE TRAIL
PEORIA AZ
85383
US

V. Phone/Fax

Practice location:
  • Phone: 623-465-8810
  • Fax: 623-465-1561
Mailing address:
  • Phone: 623-572-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4359
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: