Provider Demographics
NPI:1639256563
Name:HAMMONS, DAVID DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DOUGLAS
Last Name:HAMMONS
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 1:23496 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033
Mailing Address - Country:US
Mailing Address - Phone:408-353-3326
Mailing Address - Fax:408-353-3326
Practice Address - Street 1:55 E. JULIAN ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112
Practice Address - Country:US
Practice Address - Phone:408-453-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35991207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C359910Medicaid
A36133Medicare UPIN
CA00C359910Medicaid