Provider Demographics
NPI:1790013134
Name:H BRUCE HAMILTON, MD PA
Entity Type:Organization
Organization Name:H BRUCE HAMILTON, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-776-9775
Mailing Address - Street 1:205 WOODHEW DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6689
Mailing Address - Country:US
Mailing Address - Phone:254-776-9775
Mailing Address - Fax:254-776-9751
Practice Address - Street 1:205 WOODHEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6689
Practice Address - Country:US
Practice Address - Phone:254-776-9775
Practice Address - Fax:254-776-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1462207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
031740OtherFIRSTCARE
99670OtherSCOTT & WHITE
5292421OtherAETNA
TX2091225-01Medicaid
TXDP7834OtherMEDICARE RAILROAD
TX0A5557OtherMEDICARE PTAN
8CF004OtherBCBS
5292421OtherAETNA
99670OtherSCOTT & WHITE