Healthcare Provider Details

I. General information

NPI: 1356488126
Provider Name (Legal Business Name): SANFORD TODD HAMILTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 11/27/2023
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 E 50 S STE 211
AMERICAN FORK UT
84003-2845
US

IV. Provider business mailing address

1055 N 500 W CREDENTIALING DEPARTMENT
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-418-0870
  • Fax: 801-418-0871
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberR0986
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number7310292-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: