Provider Demographics
NPI:1104852292
Name:HAMAKER, NATHAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:C
Last Name:HAMAKER
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 1:4801 S CLIFF AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7015
Mailing Address - Country:US
Mailing Address - Phone:816-478-1230
Mailing Address - Fax:816-478-4413
Practice Address - Street 1:1613 S 7 HWY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-3946
Practice Address - Country:US
Practice Address - Phone:816-478-1230
Practice Address - Fax:816-478-4413
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007010850207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00411373OtherRAILROAD MEDICARE
406F380Medicare PIN