Provider Demographics
NPI:1053429738
Name:HAMMONS, GRANT HAROLD III (MD)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:HAROLD
Last Name:HAMMONS
Suffix:III
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3115
Mailing Address - Fax:812-235-9580
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-232-0564
Practice Address - Fax:812-242-4518
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054051A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160053259OtherRAILROAD MCARE PALAMETTO
IN200331350Medicaid
INP00855807OtherRAILROAD MEDICARE
000000191999OtherANTHEM
IN200331350XMedicaid
IN200331350AMedicaid
INP00855807OtherRAILROAD MEDICARE
IN200331350XMedicaid
H40120Medicare UPIN
IN200331350Medicaid
IN780920EEMedicare PIN