Healthcare Provider Details

I. General information

NPI: 1093886962
Provider Name (Legal Business Name): SCOTT A HAMILTON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8141 ROURK ST
MYRTLE BEACH SC
29572-4128
US

IV. Provider business mailing address

8141 ROURK ST
MYRTLE BEACH SC
29572-4128
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-8079
  • Fax: 843-497-6147
Mailing address:
  • Phone: 843-449-8079
  • Fax: 843-497-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number95
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: