Provider Demographics
NPI:1063442358
Name:HAMILTON, TONY J (DO)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:J
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:DO
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 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9964207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2350624OtherAMERICA'S PPO/ARAZ #
ND3901622OtherMEDICA #
ND13442Medicaid
ND367123200Medicaid
ND384M9HAOtherMNBS #
NDHP52809OtherHEALTHPARTNERS #
NDDA9011043845OtherPREFERRED ONE #
ND2350624OtherAMERICA'S PPO/ARAZ #
ND367123200Medicaid
NDP00236345Medicare ID - Type UnspecifiedRR MEDICARE #
NDHP52809OtherHEALTHPARTNERS #