Healthcare Provider Details

I. General information

NPI: 1174883607
Provider Name (Legal Business Name): JUSTIN KEITH HAMLIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W DAUGHERTY ST
WEBB CITY MO
64870-1717
US

IV. Provider business mailing address

1001 W DAUGHERTY ST
WEBB CITY MO
64870-1717
US

V. Phone/Fax

Practice location:
  • Phone: 417-717-2017
  • Fax: 417-717-2134
Mailing address:
  • Phone: 417-717-2017
  • Fax: 417-717-2134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5469
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-38357
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number2013030301
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number5469
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number05-38357
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License Number2013030301
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License Number5469
License Number StateOK
# 8
Primary TaxonomyN
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License Number05-38357
License Number StateKS
# 9
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2013030301
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: