Healthcare Provider Details

I. General information

NPI: 1861623928
Provider Name (Legal Business Name): ROBERT G HAMMER MD & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 CHURCHMAN AVE 200 PLAZA 3
LOUISVILLE KY
40215-1186
US

IV. Provider business mailing address

4500 CHURCHMAN AVE 200 PLAZA 3
LOUISVILLE KY
40215-1186
US

V. Phone/Fax

Practice location:
  • Phone: 502-361-1121
  • Fax: 502-361-9030
Mailing address:
  • Phone: 502-361-1121
  • Fax: 502-361-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4171P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24503
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24503
License Number StateKY

VIII. Authorized Official

Name: DR. ROBERT G HAMMER
Title or Position: OWNER
Credential: MD
Phone: 502-361-1121