Provider Demographics
NPI:1598790040
Name:HAMILTON, JACQUELINE E (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
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 1:10000 W COLONIAL DR
Mailing Address - Street 2:SUITE 285
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3498
Mailing Address - Country:US
Mailing Address - Phone:407-298-6950
Mailing Address - Fax:407-578-2354
Practice Address - Street 1:10000 W COLONIAL DR
Practice Address - Street 2:SUITE 285
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3498
Practice Address - Country:US
Practice Address - Phone:407-298-6950
Practice Address - Fax:407-578-2354
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75548208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254933600Medicaid
FL254933600Medicaid
FL43354VMedicare PIN
FLG04377Medicare UPIN
FL340017704Medicare ID - Type UnspecifiedMEDICARE RAIL ROAD
FL43354XMedicare ID - Type UnspecifiedCLERMONT OFFICE