Provider Demographics
NPI:1801069836
Name:RONALD J. HAMM, M.D. PLLC
Entity type:Organization
Organization Name:RONALD J. HAMM, M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-245-0261
Mailing Address - Street 1:11901 SHELBYVILLE RD STE 225
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1083
Mailing Address - Country:US
Mailing Address - Phone:502-245-0261
Mailing Address - Fax:502-245-8611
Practice Address - Street 1:11901 SHELBYVILLE RD STE 225
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1083
Practice Address - Country:US
Practice Address - Phone:502-245-0261
Practice Address - Fax:502-245-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7734Medicare PIN