Provider Demographics
NPI:1164489324
Name:HAMM, JEFFREY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:THOMAS
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 1:399 W CAMPBELL RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3595
Mailing Address - Country:US
Mailing Address - Phone:972-671-4266
Mailing Address - Fax:972-671-6784
Practice Address - Street 1:399 W CAMPBELL RD
Practice Address - Street 2:SUITE 402
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3595
Practice Address - Country:US
Practice Address - Phone:972-671-4266
Practice Address - Fax:972-671-6784
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8675207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE38616Medicare UPIN
TX8F0614Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMB
TX00148ZMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER