Provider Demographics
NPI:1952443582
Name:HAMON, BRYAN WADE (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:WADE
Last Name:HAMON
Suffix:
Gender:M
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:PO BOX 2508
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2508
Mailing Address - Country:US
Mailing Address - Phone:866-388-4131
Mailing Address - Fax:866-505-6933
Practice Address - Street 1:1059 BY PASS 123
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4762
Practice Address - Country:US
Practice Address - Phone:864-885-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY421002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100001990Medicaid
KYK069610Medicare PIN