Provider Demographics
NPI:1811630429
Name:HAMMACK, COLLIN EDWARD
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:EDWARD
Last Name:HAMMACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 N STADIUM DR APT 82
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4417
Mailing Address - Country:US
Mailing Address - Phone:972-302-8571
Mailing Address - Fax:
Practice Address - Street 1:4500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6876
Practice Address - Country:US
Practice Address - Phone:972-302-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37355480OtherDRIVER LICENSE