Provider Demographics
NPI:1871501874
Name:HAMMACK, MARY M (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:HAMMACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 W. PARKER RD
Mailing Address - Street 2:SUITE 234 MOB III
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8124
Mailing Address - Country:US
Mailing Address - Phone:972-981-7500
Mailing Address - Fax:972-981-3600
Practice Address - Street 1:6124 W PARKER RD
Practice Address - Street 2:MOB III SUITE 234
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8124
Practice Address - Country:US
Practice Address - Phone:972-981-7500
Practice Address - Fax:972-981-3600
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6269207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00644332OtherRAILROAD MEDICARE PTAN
TXDN8858OtherRAILROAD MEDICARE GROUP PTAN
TX116942701Medicaid
TX1487817151OtherGROUP NPI
8BL891OtherBCBS
TXP00644332OtherRAILROAD MEDICARE PTAN
TXDN8858OtherRAILROAD MEDICARE GROUP PTAN
TX00Z533Medicare PIN
TX8F8676Medicare PIN