Provider Demographics
NPI:1114994506
Name:HAMM, JEFFREY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:HAMM
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 1:4300 N UNIVERSITY DR
Mailing Address - Street 2:SUITE E-200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6249
Mailing Address - Country:US
Mailing Address - Phone:954-742-3500
Mailing Address - Fax:954-742-3503
Practice Address - Street 1:4300 N UNIVERSITY DR
Practice Address - Street 2:SUITE E-200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6249
Practice Address - Country:US
Practice Address - Phone:954-742-3500
Practice Address - Fax:954-742-3503
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME640162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME64016OtherFLORIDA MEDICAL LICENSE
FL94602AMedicare ID - Type UnspecifiedFIRST COAST SERVICE OPTIO
FLME64016OtherFLORIDA MEDICAL LICENSE