Provider Demographics
NPI:1609998731
Name:HAMMAR, MARK S (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:HAMMAR
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:37 S 2ND E STE 202
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1906
Mailing Address - Country:US
Mailing Address - Phone:208-356-0234
Mailing Address - Fax:208-656-8440
Practice Address - Street 1:37 S 2ND E STE 202
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1906
Practice Address - Country:US
Practice Address - Phone:208-356-0234
Practice Address - Fax:208-656-8440
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-734363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical