Provider Demographics
NPI:1174800213
Name:JEFFREY S. HAMMER, M.D., LLC
Entity type:Organization
Organization Name:JEFFREY S. HAMMER, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-656-1726
Mailing Address - Street 1:315 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1637
Mailing Address - Country:US
Mailing Address - Phone:618-307-5922
Mailing Address - Fax:
Practice Address - Street 1:315 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1637
Practice Address - Country:US
Practice Address - Phone:618-656-1726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2012-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.0636612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty