Provider Demographics
NPI:1720158397
Name:ALLEN J HAMAKER, MD PC
Entity Type:Organization
Organization Name:ALLEN J HAMAKER, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-949-6481
Mailing Address - Street 1:3613 NW 56TH ST.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-949-6481
Mailing Address - Fax:405-795-5908
Practice Address - Street 1:3613 NW 56TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-949-6481
Practice Address - Fax:405-795-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20735174400000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100060090AMedicaid
OK100060090AMedicaid
OK300522161Medicare PIN