Healthcare Provider Details

I. General information

NPI: 1730414897
Provider Name (Legal Business Name): LORENE HAMILTON DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 NEBRASKA AVE
GRANTS PASS OR
97527-5701
US

IV. Provider business mailing address

1819 NEBRASKA AVE
GRANTS PASS OR
97527-5701
US

V. Phone/Fax

Practice location:
  • Phone: 541-956-9085
  • Fax: 541-956-9088
Mailing address:
  • Phone: 541-956-9085
  • Fax: 541-956-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberDO25529
License Number StateOR

VIII. Authorized Official

Name: DR. LORENE L. HAMILTON
Title or Position: PRESIDENT
Credential: D.O.
Phone: 541-956-9085