Provider Demographics
NPI:1588004923
Name:HAMPTON, JEREMY EARL (DO)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:EARL
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12130 E WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2955
Practice Address - Country:US
Practice Address - Phone:317-355-7752
Practice Address - Fax:317-355-7750
Is Sole Proprietor?:No
Enumeration Date:2013-06-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2877207Q00000X
IN02004882A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01723963OtherRR MEDICARE
IN201371020Medicaid
INP01723963OtherRR MEDICARE