Basic Information
| Provider Information | |||||||||
| NPI: | 1841237740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMRE | ||||||||
| FirstName: | MERLIN | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3760 PIPER ST | ||||||||
| Address2: | SUITE 1060 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072126522 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3340 PROVIDENCE DR | ||||||||
| Address2: | SUITE 351 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072124824 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 02/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | 4301067128 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | 2080P0207X | 6481 | AK | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
| ID | Type | State | Issuer | Description | MDG798 | 01 | AK | MEDICAID MD GROUP # | OTHER | 700H262280 | 01 | BLUE CROSS-BLUE CROSS | OTHER | MD0594 | 05 | AK | MEDICAID | MH067128 | 01 | COMMERCIAL-COMMERCIAL NUMBER | OTHER | 439291010 | 05 | MI | MEDICAID | MH067128 | 01 | CHAMPUS-CHAMPUS | OTHER |