Healthcare Provider Details

I. General information

NPI: 1013970672
Provider Name (Legal Business Name): DAVID HAMILTON MSW, BCD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12MDOS/SGOHF
RANDOLPH AFB TX
78150
US

IV. Provider business mailing address

25138 FLYING ARROW
SAN ANTONIO TX
78258-2722
US

V. Phone/Fax

Practice location:
  • Phone: 210-652-6308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW-0841I
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: