Individual
MR. LARRY EVERETT HAMNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8324 CONSTITUTION PL NE, ALBUQUERQUE, NM 87110-7651
(505) 293-8000
(505) 293-8004
Mailing address
8324 CONSTITUTION PL NE, ALBUQUERQUE, NM 87110-7651
(505) 293-8000
(505) 293-8004
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-04
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
94557
—
NM
01
—
PA-04
STATE LICENSE
NM
Enumeration date
11/22/2006
Last updated
09/09/2008
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