Provider Demographics
NPI:1841219987
Name:HAMMAR, BRYAN (DO)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:HAMMAR
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 1:167 E 1ST S
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-1401
Mailing Address - Country:US
Mailing Address - Phone:208-745-8747
Mailing Address - Fax:208-745-9396
Practice Address - Street 1:167 E 1ST S
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-1401
Practice Address - Country:US
Practice Address - Phone:208-745-8747
Practice Address - Fax:208-745-9396
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDO-213OtherSTATE LICENSE
IDG52502Medicare UPIN
ID1301851Medicare ID - Type UnspecifiedMEDICARE