Provider Demographics
NPI:1043326473
Name:HAMMER, JEFFREY ALLAN (PA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLAN
Last Name:HAMMER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 7365
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-0365
Mailing Address - Country:US
Mailing Address - Phone:402-731-7333
Mailing Address - Fax:402-614-5405
Practice Address - Street 1:2429 M. STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2715
Practice Address - Country:US
Practice Address - Phone:402-731-7333
Practice Address - Fax:402-614-5405
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1111363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026075600Medicaid
NEB90782Medicare UPIN
PTAN099194Medicare PIN
IAI1347Medicare ID - Type Unspecified
NE10026075600Medicaid