Provider Demographics
NPI:1932151735
Name:HAMM, ROGER W (DPM)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:W
Last Name:HAMM
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 1:1400 S MAIN ST
Mailing Address - Street 2:SUITE A&B
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1581
Mailing Address - Country:US
Mailing Address - Phone:937-592-1004
Mailing Address - Fax:937-592-4005
Practice Address - Street 1:1400 S MAIN ST
Practice Address - Street 2:SUITE A&B
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1581
Practice Address - Country:US
Practice Address - Phone:937-592-1004
Practice Address - Fax:937-592-4005
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003384213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00627825OtherRAILROAD
OH2637865Medicaid
OH4180865Medicare PIN
OHP00627825OtherRAILROAD
OH2637865Medicaid