Provider Demographics
NPI:1710903976
Name:JEFFREY C HAMM MD LLC
Entity Type:Organization
Organization Name:JEFFREY C HAMM MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-749-3040
Mailing Address - Street 1:4340 CASPER COURT
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2414
Mailing Address - Country:US
Mailing Address - Phone:954-985-0400
Mailing Address - Fax:954-985-0405
Practice Address - Street 1:4300 NORTH UNIVERSITY DRIVE
Practice Address - Street 2:SUITE A-202
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-6244
Practice Address - Country:US
Practice Address - Phone:954-749-3040
Practice Address - Fax:954-749-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46016208200000X
MI4301044072208200000X
WI27463020208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D63281Medicare UPIN
94602Medicare ID - Type Unspecified