Individual
CORY T HAMMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
208 COLUMBUS ST, HICKSVILLE, OH 43526
(419) 542-6692
(419) 542-5667
Mailing address
208 COLUMBUS ST, HICKSVILLE, OH 43526-1250
(419) 542-6692
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001240A
IN
363AS0400X
Surgical Physician Assistant
50.004015RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000690186
ANTHEM
IN
01
—
000000690186
ANTHEM
—
05
—
0203880
—
OH
05
—
OPR
—
IN
Enumeration date
11/23/2010
Last updated
08/31/2018
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