Healthcare Provider Details

I. General information

NPI: 1760412209
Provider Name (Legal Business Name): ANDREW L HAMBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 TURTLE CREEK DR
TYLER TX
75701-1833
US

IV. Provider business mailing address

#1 CHILDREN'S WAY, SLOT 844 ACMG
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 903-595-3942
  • Fax:
Mailing address:
  • Phone: 501-364-2090
  • Fax: 501-364-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-9583
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2003020131
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberV0415
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: