Healthcare Provider Details

I. General information

NPI: 1720158397
Provider Name (Legal Business Name): ALLEN J HAMAKER, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3613 NW 56TH ST SUITE 140
OKC OK
73112
US

IV. Provider business mailing address

3613 NW 56TH ST. SUITE 140
OKC OK
73112
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-6481
  • Fax: 405-795-5908
Mailing address:
  • Phone: 405-949-6481
  • Fax: 405-795-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number20735
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLEN J HAMAKER
Title or Position: COO
Credential: MD
Phone: 405-949-6481