Provider Demographics
NPI:1124020417
Name:HAMSTRA, GERALD A (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A
Last Name:HAMSTRA
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:P.O. BOX 25819
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80936-5819
Mailing Address - Country:US
Mailing Address - Phone:719-574-7849
Mailing Address - Fax:719-574-3776
Practice Address - Street 1:4775 JAMESTOWN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2725
Practice Address - Country:US
Practice Address - Phone:719-574-7849
Practice Address - Fax:719-574-3776
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04007233Medicaid
014042929OtherRAILROAD MEDICARE
CO04007233Medicaid
COC4612Medicare PIN