Provider Demographics
NPI:1790725711
Name:HAMMONS, GREGORY TODD (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:TODD
Last Name:HAMMONS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27015 JESS MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72135-9016
Mailing Address - Country:US
Mailing Address - Phone:501-552-2650
Mailing Address - Fax:501-552-4298
Practice Address - Street 1:27015 JESS MORGAN RD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:AR
Practice Address - Zip Code:72135-9016
Practice Address - Country:US
Practice Address - Phone:501-552-2650
Practice Address - Fax:501-552-4298
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100875207P00000X
MO2005035772207P00000X
ARE-6704207P00000X
MI5101013518207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG85352OtherBLUE CROSS BLUE SHIELD
KS200369760AOtherMEDICAID
KS1000099600GOtherKANSAS MEDICAID HCFA1500
MO204642102OtherMEDICAID
MO243419306Medicaid
KS200266700BOtherMEDICAID
MOG85352OtherBLUE CROSS BLUE SHIELD
KSG85352OtherBLUE CROSS BLUE SHIELD
MOG85352OtherBLUE CROSS BLUE SHIELD