Provider Demographics
NPI:1861828691
Name:HAMMER, BRUCE RAY
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:RAY
Last Name:HAMMER
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 1:4235 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-3335
Mailing Address - Country:US
Mailing Address - Phone:630-330-3815
Mailing Address - Fax:800-513-1494
Practice Address - Street 1:4235 BEACH ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-3335
Practice Address - Country:US
Practice Address - Phone:630-330-3815
Practice Address - Fax:800-513-1494
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL13-00012412171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications