Healthcare Provider Details

I. General information

NPI: 1487579611
Provider Name (Legal Business Name): CALEB CLAYTON HAM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 E MASON ST
SPRINGFIELD IL
62701-1034
US

IV. Provider business mailing address

17593 NW GILBERT LN
PORTLAND OR
97229-8525
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-0706
  • Fax:
Mailing address:
  • Phone: 971-666-9692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: