Healthcare Provider Details

I. General information

NPI: 1033206131
Provider Name (Legal Business Name): JARRETT WESLEY HAMILTON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 FRONTAGE RD
SIERRA VISTA AZ
85635-4606
US

IV. Provider business mailing address

302 EL CAMINO REAL STE 5
SIERRA VISTA AZ
85635-2860
US

V. Phone/Fax

Practice location:
  • Phone: 520-515-7480
  • Fax: 520-459-7030
Mailing address:
  • Phone: 520-458-4335
  • Fax: 520-452-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number648
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: