Provider Demographics
NPI:1942374020
Name:HAMMOND, GREGORY D (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:HAMMOND
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 1:1580 W ANTELOPE DR STE 280
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1222
Mailing Address - Country:US
Mailing Address - Phone:801-773-0925
Mailing Address - Fax:801-773-8625
Practice Address - Street 1:613 E FORT UNION
Practice Address - Street 2:SUITE #A102
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5531
Practice Address - Country:US
Practice Address - Phone:801-294-9333
Practice Address - Fax:801-294-7558
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT55967831205207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT55967831202001OtherBLUE SHIELD
UT005769101Medicare PIN
UT55967831202001OtherBLUE SHIELD
UT000068728Medicare PIN