Provider Demographics
NPI:1356301816
Name:HAMN, STEPHEN VICTOR (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:VICTOR
Last Name:HAMN
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 1:3108 MIDWAY RD STE 204
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-1615
Mailing Address - Country:US
Mailing Address - Phone:972-845-4567
Mailing Address - Fax:972-845-4448
Practice Address - Street 1:3108 MIDWAY RD STE 204
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1615
Practice Address - Country:US
Practice Address - Phone:972-845-4567
Practice Address - Fax:972-845-4448
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1282208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099267901Medicaid
TX00L20FMedicare ID - Type Unspecified