Provider Demographics
NPI:1083731756
Name:HAMMETT, CHAD W (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:W
Last Name:HAMMETT
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 1:755 N. 11TH STREET
Mailing Address - Street 2:SUITE P5200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1522
Mailing Address - Country:US
Mailing Address - Phone:409-898-2994
Mailing Address - Fax:409-898-2592
Practice Address - Street 1:755 N. 11TH STREET
Practice Address - Street 2:SUITE P5200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1522
Practice Address - Country:US
Practice Address - Phone:409-898-2994
Practice Address - Fax:409-898-2592
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6173208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0086QCOtherBLUE CROSS GROUP
TX8AM760OtherBLUE CROSS
TX0086QCOtherBLUE CROSS GROUP