1194847533 NPI number — MR. LESTER ALVIN HAMMOND III P.T.

Table of content: MR. LESTER ALVIN HAMMOND III P.T. (NPI 1194847533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194847533 NPI number — MR. LESTER ALVIN HAMMOND III P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMMOND
Provider First Name:
LESTER
Provider Middle Name:
ALVIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMMOND
Provider Other First Name:
TREY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1194847533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 SE 17TH ST
Provider Second Line Business Mailing Address:
#309-217
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-4423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5036 SE 110TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34420-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-693-3378
Provider Business Practice Location Address Fax Number:
888-758-9645
Provider Enumeration Date:
04/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT18770 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y001Q . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".