Provider Demographics
NPI:1245256197
Name:HAMMERMAN, HARLEY J (MD)
Entity type:Individual
Prefix:DR
First Name:HARLEY
Middle Name:J
Last Name:HAMMERMAN
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 1:11615 OLIVE BLVD
Mailing Address - Street 2:METRO IMAGING
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7095
Mailing Address - Country:US
Mailing Address - Phone:314-993-9555
Mailing Address - Fax:314-432-0178
Practice Address - Street 1:11615 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7095
Practice Address - Country:US
Practice Address - Phone:314-993-9555
Practice Address - Fax:314-993-9550
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR68692085R0202X
IL0360586992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL300099491OtherRAILROAD MEDICARE NUMBER
MO201203502Medicaid
IL036058699Medicaid
MO300102475OtherRAILROAD MEDICARE NUMBER
MO201203502Medicaid
MO002010350Medicare ID - Type UnspecifiedMO MEDICARE NUMBER
IL036058699Medicaid
A12584Medicare UPIN