Provider Demographics
NPI:1578756003
Name:GREGORY D HAMMOND MD PC
Entity Type:Organization
Organization Name:GREGORY D HAMMOND MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-294-9333
Mailing Address - Street 1:1580 W ANTELOPE DR STE 280
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1222
Mailing Address - Country:US
Mailing Address - Phone:801-773-0925
Mailing Address - Fax:801-773-8625
Practice Address - Street 1:520 MEDICAL DR STE 200
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8928
Practice Address - Country:US
Practice Address - Phone:801-294-9333
Practice Address - Fax:801-284-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT55967831205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT518085206001Medicaid