MEDICARE: DR. CLARK HAMILTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	19916	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19916	OTHER	OK	MEDICAL LICENSE

General Provider Information

NPI Number	:	1033193214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARK HAMILTON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 30589
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73140-3589
Country	:	US
Telephone Number	:	405-769-3301
Fax Number	:	405-769-9685

Provider Business Practice Location Address
First Line	:	12716 NE 36TH ST
Second Line	:
City	:	SPENCER
State	:	OK
Zip	:	73084-9103
Country	:	US
Telephone Number	:	405-769-3301
Fax Number	:	405-769-9685

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. CLARK HAMILTON M.D.” Practice Location

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