Individual
MATHEW HOUSTON HAMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1102 W 32ND ST, JOPLIN, MO 64804-3503
(417) 347-1111
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2012036269
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431560263
TRICARE
MO
01
—
P01183859
RR MCR
MO
Enumeration date
01/14/2011
Last updated
06/09/2021
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