Healthcare Provider Details

I. General information

NPI: 1255379970
Provider Name (Legal Business Name): SEAN R HAMLETT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W BROADWAY
COLUMBIA MO
65203-2125
US

IV. Provider business mailing address

1205 W BROADWAY
COLUMBIA MO
65203-2125
US

V. Phone/Fax

Practice location:
  • Phone: 573-355-0929
  • Fax: 573-234-6301
Mailing address:
  • Phone: 573-355-0929
  • Fax: 573-234-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2002010578
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: