=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790013134
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | H BRUCE HAMILTON, MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2009
-----------------------------------------------------
Last Update Date | 10/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 WOODHEW DR SUITE 200
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76712-6689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-776-9775
-----------------------------------------------------
Fax | 254-776-9751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 WOODHEW DR SUITE 200
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76712-6689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-776-9775
-----------------------------------------------------
Fax | 254-776-9751
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HAROLD BRUCE HAMILTON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 254-776-9775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | K1462
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------