Provider Demographics
NPI:1457342503
Name:HAMMOND, ALBERT S III (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:S
Last Name:HAMMOND
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-240-2205
Mailing Address - Fax:320-229-5174
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-240-2205
Practice Address - Fax:320-229-5174
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN40946207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CU0204OtherRR MEDICARE
085518900OtherMEDICAL ASSISTANCE
110167916OtherRR MEDICARE
122981OtherU CARE
1017113OtherPREFERRED ONE
2114137OtherFIRST HEALTH PLAN
2900213OtherMEDICA HEALTH PLANS
507R1HAOtherBLUE CROSS BLUE SHIELD
HP26179OtherHEALTH PARTNERS
50Q94HAOtherBLUE CROSS BLUE SHIELD
786245OtherARAZ GROUP AMERICAS PPO
HP26179OtherHEALTH PARTNERS
786245OtherARAZ GROUP AMERICAS PPO