Provider Demographics
NPI:1326028663
Name:HAMAKER, ALLEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:J
Last Name:HAMAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 NW 56TH ST.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-949-6481
Mailing Address - Fax:405-795-5908
Practice Address - Street 1:3613 NW 56TH ST.
Practice Address - Street 2:SUITE 140
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-949-6481
Practice Address - Fax:405-795-5908
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100060090AMedicaid
OKF39402Medicare UPIN
OK100060090AMedicaid