Provider Demographics
NPI:1821262841
Name:GERALD A. HAMSTRA, D.O., P.C.
Entity Type:Organization
Organization Name:GERALD A. HAMSTRA, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-574-7849
Mailing Address - Street 1:PO BOX 25819
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80936-5819
Mailing Address - Country:US
Mailing Address - Phone:719-574-7849
Mailing Address - Fax:719-574-3776
Practice Address - Street 1:4775 JAMESTOWN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2725
Practice Address - Country:US
Practice Address - Phone:719-574-7849
Practice Address - Fax:719-574-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01174952Medicaid
014042929OtherRAILROAD MEDICARE
COD23288Medicare UPIN
COC4612Medicare PIN