Provider Demographics
NPI:1750311247
Name:HAMIL, WADE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:L
Last Name:HAMIL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 SHADOWRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-5308
Mailing Address - Country:US
Mailing Address - Phone:405-573-9905
Mailing Address - Fax:888-753-8162
Practice Address - Street 1:448 36TH AVE NW
Practice Address - Street 2:SUITE 101
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4746
Practice Address - Country:US
Practice Address - Phone:405-627-0276
Practice Address - Fax:888-753-8162
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK785103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100635990 DMedicaid
OK20006OtherSELECTCARE OF OKLAHOMA
OK100635990 DMedicaid