Provider Demographics
NPI:1124064845
Name:HAMMOND, TERRY C (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:C
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:1175 E 50 S STE 161
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2845
Practice Address - Country:US
Practice Address - Phone:801-377-4623
Practice Address - Fax:801-377-6832
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT311723-1205207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT31-00050OtherUNITED HEALTHCARE
UT232243OtherDMBA
110224652OtherPALMETTO GBA
UTQM0000044582OtherALTIUS
UT870281028HA1OtherEMIA
UT107008159101OtherIHC
UT62052OtherPEHP
UT870281028000Medicaid