Provider Demographics
NPI:1639159239
Name:HAMILTON, JONATHAN T (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:T
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 PINE GROVE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8803
Mailing Address - Country:US
Mailing Address - Phone:970-879-0203
Mailing Address - Fax:970-879-1389
Practice Address - Street 1:1475 PINE GROVE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8803
Practice Address - Country:US
Practice Address - Phone:970-879-0203
Practice Address - Fax:970-879-1389
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO52103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48759554Medicaid
OKP00319866OtherRAILROAD MEDICARE
CO1639159239OtherMEDICARE
OK7337760OtherAETNA
OKP00389811OtherRAILROAD MEDICARE
OK7649720OtherAETNA
OK7649720OtherAETNA
OKP00389811OtherRAILROAD MEDICARE
OK$$$$$$$$$004OtherBLUE CROSS
OK248601301Medicare PIN
OK7649720OtherAETNA