Healthcare Provider Details

I. General information

NPI: 1619918919
Provider Name (Legal Business Name): JEFFREY A HAMM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 6TH ST STE 302
PANAMA CITY FL
32401-3699
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-1431
US

V. Phone/Fax

Practice location:
  • Phone: 850-770-3250
  • Fax: 850-770-3255
Mailing address:
  • Phone: 361-572-0333
  • Fax: 361-703-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA-654
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9110525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: