Healthcare Provider Details

I. General information

NPI: 1932178340
Provider Name (Legal Business Name): THOMAS M. HEMMER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W 21ST ST STE A-1
CLOVIS NM
88101-4087
US

IV. Provider business mailing address

2000 W 21ST ST STE A-1
CLOVIS NM
88101-4087
US

V. Phone/Fax

Practice location:
  • Phone: 575-762-8055
  • Fax: 575-763-3351
Mailing address:
  • Phone: 575-762-8055
  • Fax: 575-763-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS012890
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: