Provider Demographics
NPI:1710972039
Name:HAMILTON, MARK L (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3857 STOCKDALE HWY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2187
Mailing Address - Country:US
Mailing Address - Phone:661-832-1667
Mailing Address - Fax:661-832-7145
Practice Address - Street 1:3857 STOCKDALE HWY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2187
Practice Address - Country:US
Practice Address - Phone:661-832-1667
Practice Address - Fax:661-832-7145
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE-3008213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAH1279529OtherDEA
T11549Medicare UPIN
CAZZZ22507ZMedicare PIN