Provider Demographics
NPI:1083617377
Name:HAMILTON, LORENE (DO)
Entity Type:Individual
Prefix:DR
First Name:LORENE
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5701
Mailing Address - Country:US
Mailing Address - Phone:541-956-8800
Mailing Address - Fax:541-956-9088
Practice Address - Street 1:1819 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5701
Practice Address - Country:US
Practice Address - Phone:541-956-8800
Practice Address - Fax:541-956-9088
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO25529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276264Medicaid