Provider Demographics
NPI:1790788628
Name:HAMILTON, MURRAY O (MD)
Entity Type:Individual
Prefix:
First Name:MURRAY
Middle Name:O
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11995 SINGLETREE LN STE 500
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5349
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:11995 SINGLETREE LN STE 500
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5349
Practice Address - Country:US
Practice Address - Phone:952-595-1301
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK202562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100108450AMedicaid
OKP00144973OtherRAILROAD MEDICARE
OKP00276166OtherRAILROAD MEDICARE/AI
OKOKA100770Medicare PIN
OK244421004Medicare ID - Type Unspecified
OK242419501Medicare ID - Type Unspecified
OK2RADIA019Medicare ID - Type Unspecified
OKMDLPL022Medicare ID - Type Unspecified
OKP00276166Medicare PIN
OKH35793Medicare UPIN
OK100108450AMedicaid
OKP00276166OtherRAILROAD MEDICARE/AI