Healthcare Provider Details

I. General information

NPI: 1821345075
Provider Name (Legal Business Name): CARLOS R HAMILTON III MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22751 PROFESSIONAL DR SUITE 240
KINGWOOD TX
77339-6021
US

IV. Provider business mailing address

4690 SWEETWATER BLVD SUITE 200
SUGAR LAND TX
77479-3467
US

V. Phone/Fax

Practice location:
  • Phone: 281-565-0033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberTXJ8564
License Number StateTX

VIII. Authorized Official

Name: CARLOS R HAMILTON III
Title or Position: PRESIDENT
Credential: MD
Phone: 281-565-0033