Provider Demographics
NPI:1033206131
Name:HAMILTON, JARRETT WESLEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JARRETT
Middle Name:WESLEY
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 EL CAMINO REAL
Mailing Address - Street 2:STE 5
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2860
Mailing Address - Country:US
Mailing Address - Phone:520-458-4335
Mailing Address - Fax:520-452-2232
Practice Address - Street 1:1951 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4606
Practice Address - Country:US
Practice Address - Phone:520-515-7480
Practice Address - Fax:520-459-7030
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ648213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ193106Medicaid
AZ193106Medicaid
AZV11475Medicare UPIN