Provider Demographics
NPI:1619918919
Name:HAMM, JEFFREY A (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:HAMM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1431
Mailing Address - Country:US
Mailing Address - Phone:361-572-0333
Mailing Address - Fax:361-703-5101
Practice Address - Street 1:801 E 6TH ST
Practice Address - Street 2:STE 302
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3699
Practice Address - Country:US
Practice Address - Phone:850-770-3250
Practice Address - Fax:850-770-3255
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-654363AS0400X
FLPA9110525363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME254420099Medicaid
FL021892900Medicaid
NH30337326Medicaid
MEAP129201Medicare PIN
MEAP1292Medicare PIN
NH30337326Medicaid
MEAP129202Medicare PIN