Healthcare Provider Details

I. General information

NPI: 1841458049
Provider Name (Legal Business Name): LAURA HAMMONS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2008
Last Update Date: 05/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 E AZTEC AVE
GALLUP NM
87301-4804
US

IV. Provider business mailing address

504 ZECCA DR
GALLUP NM
87301-4847
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNM89-43
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: