Provider Demographics
NPI:1033126289
Name:HAMILTON, PAUL M (PHD PC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PHD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2221
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78381-2221
Mailing Address - Country:US
Mailing Address - Phone:361-727-0143
Mailing Address - Fax:361-727-2036
Practice Address - Street 1:101 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-2748
Practice Address - Country:US
Practice Address - Phone:361-727-0143
Practice Address - Fax:361-727-2036
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26879103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031290201Medicaid
TXS-43530Medicare UPIN
TX031290201Medicaid