Provider Demographics
NPI:1275672347
Name:HAMILTON, SEAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHAEL
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4532
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-4532
Mailing Address - Country:US
Mailing Address - Phone:361-575-8346
Mailing Address - Fax:
Practice Address - Street 1:1701 E RED RIVER ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5621
Practice Address - Country:US
Practice Address - Phone:361-575-8346
Practice Address - Fax:361-575-8351
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45278208600000X
TXM6646208600000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BW612OtherBLUECROSS BLUESHIELD
TX8L9090Medicare PIN