Provider Demographics
NPI:1497883789
Name:HAMBLIN, JEFFREY FLINT (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:FLINT
Last Name:HAMBLIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATT BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:580-920-2273
Mailing Address - Fax:
Practice Address - Street 1:1807 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3011
Practice Address - Country:US
Practice Address - Phone:580-920-2273
Practice Address - Fax:580-920-9978
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05221363A00000X
OK811363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP01469754OtherRR MEDICARE
TX345749101Medicaid
TXP01492274OtherRR MEDICARE
OKS40561Medicare UPIN
TX406463YMCMMedicare UPIN
OK397002ZMALMedicare PIN