Provider Demographics
NPI:1497815880
Name:HAMILTON, DOUGLAS G (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:G
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12021 WILSHIRE BLVD
Mailing Address - Street 2:#309
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1206
Mailing Address - Country:US
Mailing Address - Phone:818-884-7150
Mailing Address - Fax:818-884-1254
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:301
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2006
Practice Address - Country:US
Practice Address - Phone:818-884-7150
Practice Address - Fax:818-884-1254
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG20987207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G20987Medicare ID - Type Unspecified
CAA41125Medicare UPIN