Healthcare Provider Details

I. General information

NPI: 1477198638
Provider Name (Legal Business Name): TERRENCE R HAMILTON PA-CERTIFIED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 10/11/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST MED BATTALION, 1ST MLG PO BOX 55657
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

1ST MED BATTALION, 1ST MLG PO BOX 55657
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 920-946-6601
  • Fax:
Mailing address:
  • Phone: 920-946-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number13850
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: