Provider Demographics
NPI:1053309898
Name:HAMILTON, LANCE LEE (MD)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:LEE
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2618 SE J ST
Mailing Address - Street 2:STE 12
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3857
Mailing Address - Country:US
Mailing Address - Phone:479-715-6505
Mailing Address - Fax:479-340-0015
Practice Address - Street 1:2618 SE J ST
Practice Address - Street 2:STE 12
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3857
Practice Address - Country:US
Practice Address - Phone:479-715-6505
Practice Address - Fax:479-340-0015
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARN8166207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121148001Medicaid
AR121148801Medicaid
OK100125440AMedicaid
AR121148801Medicaid
ARE99124Medicare UPIN