Provider Demographics
NPI:1477198638
Name:HAMILTON, TERRENCE R (PA-CERTIFIED)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:R
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PA-CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PROBANDT UNIT 226
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1991
Mailing Address - Country:US
Mailing Address - Phone:920-946-6601
Mailing Address - Fax:
Practice Address - Street 1:4101 FARENHOLT AV BLDG 14
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-0001
Practice Address - Country:US
Practice Address - Phone:904-504-7542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider