Provider Demographics
NPI:1376578443
Name:HAMILTON, KATHRYN R (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:R
Last Name:HAMILTON
Suffix:
Gender:F
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:PO BOX 34717
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-4717
Mailing Address - Country:US
Mailing Address - Phone:210-615-1187
Mailing Address - Fax:210-614-2180
Practice Address - Street 1:4242 MEDICAL DR
Practice Address - Street 2:SUITE 1300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5640
Practice Address - Country:US
Practice Address - Phone:210-615-1187
Practice Address - Fax:210-614-2180
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3675207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF77696Medicare UPIN
TX80178KMedicare ID - Type Unspecified