Provider Demographics
NPI:1841237740
Name:HAMRE, MERLIN R (MD)
Entity Type:Individual
Prefix:
First Name:MERLIN
Middle Name:R
Last Name:HAMRE
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 1:3760 PIPER ST
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4665
Mailing Address - Country:US
Mailing Address - Phone:907-212-6522
Mailing Address - Fax:
Practice Address - Street 1:3340 PROVIDENCE DR
Practice Address - Street 2:SUITE 351
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4691
Practice Address - Country:US
Practice Address - Phone:907-212-4824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010671282080P0207X
AK64812080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG798OtherMEDICAID MD GROUP #
700H262280OtherBLUE CROSS-BLUE CROSS
AKMD0594Medicaid
MH067128OtherCOMMERCIAL-COMMERCIAL NUMBER
MI439291010Medicaid
MH067128OtherCHAMPUS-CHAMPUS
0H26228319Medicare ID - Type Unspecified
MI439291010Medicaid