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General NPI Number Information
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NPI Number | 1952443582
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Entity Type | Individual
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Provider Name | BRYAN WADE HAMON MD
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 1059 BY PASS 123
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City | SENECA
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State | SC
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Zip | 29678-4762
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Country | US
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Telephone | 864-885-0551
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2508
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-2508
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Country | US
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Telephone | 866-388-4131
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Fax | 866-505-6933
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 42100
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License Number State | KY
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