Provider Demographics
NPI:1912939042
Name:HAMM, JENNIFER R (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:HAMM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S JACKSON ST
Mailing Address - Street 2:ACB/2ND FLOOR
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:#410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-571-5999
Practice Address - Fax:502-271-5994
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89445207V00000X
KY44130207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269635500Medicaid
FL43302XMedicare PIN
FL43302YMedicare PIN
FLI13804Medicare UPIN
FL269635500Medicaid
KYP400043449Medicare PIN
FL43302ZMedicare PIN