Provider Demographics
NPI:1619460144
Name:HAMACHER, SHANE JEREMY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:JEREMY
Last Name:HAMACHER
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 1:3831 PIPER ST STE S433
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-6900
Mailing Address - Country:US
Mailing Address - Phone:079-561-1421
Mailing Address - Fax:907-561-0327
Practice Address - Street 1:3901 RAINBOW BLVD # MS 1060
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-945-7483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-09
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-09516207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology