Provider Demographics
NPI:1568419638
Name:HAMM, JOSEPH HENRY (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HENRY
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 1:1101 MOULTON AND PARSONS DRIVE
Mailing Address - Street 2:PO BOX 460
Mailing Address - City:ST JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081-0460
Mailing Address - Country:US
Mailing Address - Phone:507-375-3391
Mailing Address - Fax:507-375-8635
Practice Address - Street 1:1101 MOULTON AND PARSONS DRIVE
Practice Address - Street 2:
Practice Address - City:ST JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-0460
Practice Address - Country:US
Practice Address - Phone:507-375-3391
Practice Address - Fax:507-375-8635
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN029215000Medicaid