Provider Demographics
NPI:1225033194
Name:HAMON, GREGORY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
Last Name:HAMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24723 CLEARWATER RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3479
Mailing Address - Country:US
Mailing Address - Phone:210-787-9048
Mailing Address - Fax:210-610-0211
Practice Address - Street 1:1200 BROOKLYN AVE STE 150
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4815
Practice Address - Country:US
Practice Address - Phone:210-627-1904
Practice Address - Fax:210-610-0211
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8107202K00000X, 2086S0129X, 208600000X
CAA049434208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AQ890OtherBCBSTX
TX1961534-01OtherMEDICAID TPI
CA00A494341Medicaid
TX7131262OtherAETNA PIN
TX8F7292Medicare PIN