Provider Demographics
NPI:1861623928
Name:ROBERT G HAMMER MD & ASSOCIATES
Entity type:Organization
Organization Name:ROBERT G HAMMER MD & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-361-1121
Mailing Address - Street 1:4500 CHURCHMAN AVE
Mailing Address - Street 2:200 PLAZA 3
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1186
Mailing Address - Country:US
Mailing Address - Phone:502-361-1121
Mailing Address - Fax:502-361-9030
Practice Address - Street 1:4500 CHURCHMAN AVE
Practice Address - Street 2:200 PLAZA 3
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1186
Practice Address - Country:US
Practice Address - Phone:502-361-1121
Practice Address - Fax:502-361-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4171P163WG0000X
KY24503208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000632751OtherANTHEM
KY01104Medicare PIN