Healthcare Provider Details

I. General information

NPI: 1174675003
Provider Name (Legal Business Name): RICHARD EDWARD HAMILTON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1582 FOREST TRAIL
MAMMOTH LAKES CA
93546
US

IV. Provider business mailing address

PO BOX 1813
MAMMOTH LAKES CA
93546-1813
US

V. Phone/Fax

Practice location:
  • Phone: 760-914-0693
  • Fax: 760-934-3215
Mailing address:
  • Phone: 760-914-0693
  • Fax: 760-934-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG034133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: