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NPI Code Detail

MEDICARE: DR. BRYAN WADE HAMON MD

MEDICARE: DR. BRYAN WADE HAMON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician42100KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952443582
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRYAN WADE HAMON MD
Provider Business Mailing Address
First Line : PO BOX 2508
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46206-2508
Country : US
Telephone Number : 866-388-4131
Fax Number : 866-505-6933
Provider Business Practice Location Address
First Line : 1059 BY PASS 123
Second Line :
City : SENECA
State : SC
Zip : 29678-4762
Country : US
Telephone Number : 864-885-0551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 08/26/2024

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