Provider Demographics
NPI:1356874051
Name:HAMMOND, JEFFREY ROBERT (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 N 560 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5927
Mailing Address - Country:US
Mailing Address - Phone:801-850-1008
Mailing Address - Fax:
Practice Address - Street 1:365 W. 2230 N.
Practice Address - Street 2:SUITE 103
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-377-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2023-09-08
Deactivation Date:2023-09-01
Deactivation Code:
Reactivation Date:2023-09-08
Provider Licenses
StateLicense IDTaxonomies
UT12282134-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty