Provider Demographics
NPI:1538570577
Name:HAMMOCK, MICHAEL JR (O)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:HAMMOCK
Suffix:JR
Gender:M
Credentials:O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS ARLEIGH BURKE DDG 51
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09565-1269
Mailing Address - Country:US
Mailing Address - Phone:757-444-4232
Mailing Address - Fax:
Practice Address - Street 1:USS ARLEIGH BURKE DDG 51
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09565-1269
Practice Address - Country:US
Practice Address - Phone:757-444-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1710L1002X1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman