Provider Demographics
NPI:1558302190
Name:HAMILTON, STEPHEN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOSEPH
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 1:832 THOMAS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3206
Mailing Address - Country:US
Mailing Address - Phone:817-874-7446
Mailing Address - Fax:
Practice Address - Street 1:108 DENVER TRL
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3614
Practice Address - Country:US
Practice Address - Phone:817-444-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4419207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153139413Medicaid
TX0069NGOtherBLUE CROSS BLUE SHIELD
TX0069NGOtherBLUE CROSS BLUE SHIELD
TXP00315366Medicare PIN
TXH69553Medicare UPIN