Provider Demographics
NPI:1053301911
Name:HAMMER, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HAMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 N JACOB ALLCOTT WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687
Mailing Address - Country:US
Mailing Address - Phone:208-461-8700
Mailing Address - Fax:208-461-8705
Practice Address - Street 1:1209 N JACOB ALLCOTT WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687
Practice Address - Country:US
Practice Address - Phone:208-461-8700
Practice Address - Fax:208-461-8705
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6666208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010005678OtherBLUE SHIELD
ID33266OtherBLUE CROSS
ID805527400Medicaid
ID46151OtherBLUE CROSS
ID80635330OtherHEALTHY CONNECTIONS
ID000010005679OtherBLUE SHIELD
ID33191OtherBLUE CROSS
ID000010135658OtherBLUE SHIELD
ID000010135658OtherBLUE SHIELD
ID33191OtherBLUE CROSS
ID1142629Medicare ID - Type Unspecified