Provider Demographics
NPI:1124016480
Name:HAMER, WYNDOL SPAN JR (MD)
Entity Type:Individual
Prefix:
First Name:WYNDOL
Middle Name:SPAN
Last Name:HAMER
Suffix:JR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1700 CHRISTINE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-3812
Mailing Address - Country:US
Mailing Address - Phone:256-294-7004
Mailing Address - Fax:256-294-7005
Practice Address - Street 1:1700 CHRISTINE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3812
Practice Address - Country:US
Practice Address - Phone:256-294-7004
Practice Address - Fax:256-294-7005
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2014-07-18
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Provider Licenses
StateLicense IDTaxonomies
AL9756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC73430Medicare UPIN
AL051555801HAMMedicare ID - Type UnspecifiedPROVIDER NUMBER