Healthcare Provider Details

I. General information

NPI: 1275717167
Provider Name (Legal Business Name): STANLEY A HAMMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAMC ANX BLDG 9926A
TACOMA WA
98431-0001
US

IV. Provider business mailing address

901 E WRIGHT AVE
TACOMA WA
98404-3247
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4700
  • Fax:
Mailing address:
  • Phone: 253-272-5224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00056407
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: