Provider Demographics
NPI:1245219807
Name:HAMNER, CHAD E (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:E
Last Name:HAMNER
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER STREET
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TE
Practice Address - Zip Code:76104
Practice Address - Country:UM
Practice Address - Phone:682-885-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42653208600000X
TXN30672086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN827955100Medicaid
MN827955100Medicaid
MN020046822Medicare ID - Type UnspecifiedRAILROAD
H20476Medicare UPIN