Provider Demographics
NPI:1821758335
Name:HAMILTON, ERIC JOSEPH JR
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOSEPH
Last Name:HAMILTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5267 BARBARA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-1301
Mailing Address - Country:US
Mailing Address - Phone:702-640-6103
Mailing Address - Fax:
Practice Address - Street 1:5267 BARBARA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-1301
Practice Address - Country:US
Practice Address - Phone:702-640-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty