Healthcare Provider Details

I. General information

NPI: 1649501347
Provider Name (Legal Business Name): CARLOS R HAMILTON III MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4690 SWEETWATER BLVD SUITE 200
SUGAR LAND TX
77479-3467
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: 281-565-0568
Mailing address:
  • Phone: 281-565-0033
  • Fax: 281-565-0568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberJ8564
License Number StateTX

VIII. Authorized Official

Name: DR. CARLOS R HAMILTON III
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 713-397-3594