Provider Demographics
NPI:1265446827
Name:HAMILL, GEOFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:S
Last Name:HAMILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WESTPORT PLZ
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3109
Mailing Address - Country:US
Mailing Address - Phone:314-548-4772
Mailing Address - Fax:314-548-4748
Practice Address - Street 1:3015 N NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-996-5180
Practice Address - Fax:314-821-2180
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1124392085R0202X
IL0361087362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0090000352OtherIL BLUE
107925OtherBLUE CHOICE
208892901OtherMO CAID
9810OtherHCARE USA
001013128OtherCARE
001013128OtherMO CARE
1078069OtherMC MCAID
398319OtherHLT PART
336345OtherH LINK
025012444OtherMO CARE
1390OtherMO BLUE
1608900OtherPH PLAN
A12512OtherGATE WAY
025012444OtherCARE
300074486OtherRR CARE
2781OtherGHP
431725842MIDOtherMERCY
025012444OtherCARE
1078069OtherMC MCAID