Provider Demographics
NPI:1790285781
Name:KAMMERMAN, JACOB SEAMUS (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:SEAMUS
Last Name:KAMMERMAN
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:III MEF SURGEON ATTN: MSSP
Mailing Address - Street 2:UNIT: 35605
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96382-5605
Mailing Address - Country:US
Mailing Address - Phone:607-349-8777
Mailing Address - Fax:
Practice Address - Street 1:III MEF
Practice Address - Street 2:ATTN: MSSP UNIT: 35605
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96382-5605
Practice Address - Country:US
Practice Address - Phone:607-349-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101267976171000000X, 208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program