Healthcare Provider Details

I. General information

NPI: 1083617377
Provider Name (Legal Business Name): LORENE HAMILTON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
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: 541-956-8800
  • Fax: 541-956-9088
Mailing address:
  • Phone: 541-956-8800
  • Fax: 541-956-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO25529
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: