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General NPI Number Information
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NPI Number | 1821262841
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Entity Type | Organization
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Legal Business Name | GERALD A. HAMSTRA, D.O., P.C.
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 4775 JAMESTOWN DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-2725
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Country | US
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Telephone | 719-574-7849
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Fax | 719-574-3776
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Provider Business Mailing Address
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Address Line | PO BOX 25819
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City | COLORADO SPRINGS
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State | CO
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Zip | 80936-5819
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Country | US
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Telephone | 719-574-7849
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Fax | 719-574-3776
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GERALD A HAMSTRA
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Credential | D.O.
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Telephone | 719-574-7849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17495
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License Number State | CO
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