Provider Demographics
NPI: | 1760412209 |
---|---|
Name: | HAMBY, ANDREW L (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ANDREW |
Middle Name: | L |
Last Name: | HAMBY |
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: | #1 CHILDREN'S WAY, SLOT 844 |
Mailing Address - Street 2: | ACMG |
Mailing Address - City: | LITTLE ROCK |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72202-3500 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 501-364-2090 |
Mailing Address - Fax: | 501-364-3929 |
Practice Address - Street 1: | 2601 GENE GEORGE BLVD |
Practice Address - Street 2: | |
Practice Address - City: | SPRINGDALE |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72762-0845 |
Practice Address - Country: | US |
Practice Address - Phone: | 479-725-6880 |
Practice Address - Fax: | 479-725-6582 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-03 |
Last Update Date: | 2024-05-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | V0415 | 208000000X |
MO | 2003020131 | 208000000X |
AR | E-9583 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 209083005 | Medicaid | |
AR | 215364001 | Medicaid | |
OK | 200014340A | Medicaid | |
KS | 100643070A | Medicaid | |
MO | 181341 | Other | ANTHEM |
KS | 100643070A | Medicaid |