Provider Demographics
NPI:1487680559
Name:HAMILTON, HERBERT E (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:E
Last Name:HAMILTON
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:PO BOX 4975
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74159-0975
Mailing Address - Country:US
Mailing Address - Phone:918-747-4975
Mailing Address - Fax:918-743-9058
Practice Address - Street 1:4111 S DARLINGTON AVE
Practice Address - Street 2:STE 700
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6348
Practice Address - Country:US
Practice Address - Phone:918-747-4975
Practice Address - Fax:918-743-9058
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK191202085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100823960BMedicaid
OK249720702Medicare PIN
B65401Medicare UPIN