Provider Demographics
NPI:1700031861
Name:HAMMOND, DWAYNE ERIC (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:ERIC
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:500 SW 39TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4915
Mailing Address - Country:US
Mailing Address - Phone:425-264-2568
Mailing Address - Fax:425-264-2569
Practice Address - Street 1:500 SW 39TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4915
Practice Address - Country:US
Practice Address - Phone:425-264-2568
Practice Address - Fax:425-264-2569
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60055660363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical