Healthcare Provider Details

I. General information

NPI: 1386243426
Provider Name (Legal Business Name): RODNEY L HAMMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 N MAIN ST STE 309
LOGAN UT
84321-5143
US

IV. Provider business mailing address

179 N MAIN ST STE 309
LOGAN UT
84321-5143
US

V. Phone/Fax

Practice location:
  • Phone: 435-755-1670
  • Fax:
Mailing address:
  • Phone: 435-755-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number1998002008
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: