Provider Demographics
NPI:1932178340
Name:HEMMER, THOMAS M (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:HEMMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W 21ST ST
Mailing Address - Street 2:STE A-1
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4087
Mailing Address - Country:US
Mailing Address - Phone:575-762-8055
Mailing Address - Fax:575-763-3351
Practice Address - Street 1:2000 W 21ST ST
Practice Address - Street 2:STE A-1
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4087
Practice Address - Country:US
Practice Address - Phone:575-762-8055
Practice Address - Fax:575-763-3351
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012890207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008283670001Medicaid
NMA-1725-13OtherNM LICENSE
PAHE076878Medicare PIN
NMA-1725-13OtherNM LICENSE