Provider Demographics
NPI:1114388204
Name:HAMMON, BRAD WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:WILLIAM
Last Name:HAMMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 W MOANA LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4903
Mailing Address - Country:US
Mailing Address - Phone:775-324-0699
Mailing Address - Fax:
Practice Address - Street 1:640 W MOANA LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4903
Practice Address - Country:US
Practice Address - Phone:775-350-7831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2956207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology