Provider Demographics
NPI:1164967154
Name:HAMILTON R FISH MD
Entity Type:Organization
Organization Name:HAMILTON R FISH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDIVIDUAL
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMILTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-728-3111
Mailing Address - Street 1:32735 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3900
Mailing Address - Country:US
Mailing Address - Phone:352-728-3111
Mailing Address - Fax:352-728-3201
Practice Address - Street 1:32735 RADIO RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3900
Practice Address - Country:US
Practice Address - Phone:352-728-3111
Practice Address - Fax:352-728-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038286800Medicaid
FL038286800Medicaid