Provider Demographics
NPI:1972669083
Name:HAMMOND, DAVID EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EARL
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 E PARIS AVE SE
Mailing Address - Street 2:SUITE #214
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3691
Mailing Address - Country:US
Mailing Address - Phone:616-957-2060
Mailing Address - Fax:616-957-0388
Practice Address - Street 1:801 YORK ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4630
Practice Address - Country:US
Practice Address - Phone:866-630-9882
Practice Address - Fax:920-683-2131
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4304037620207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0411316OtherBCBS OF MICHIGAN
MIB45694Medicare UPIN
MI2108380Medicaid
MI0410004Medicare PIN