=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700205770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWIN H HAMILTON PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2014
-----------------------------------------------------
Last Update Date | 05/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2323 NW 19TH ST SUITE 2
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311-3400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-484-8333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 NE FIRST STREET
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-484-8333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. EDWIN H HAMILTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-484-8333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME9778
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------