Provider Demographics
NPI:1922044577
Name:HAMILTON, JILL M (NP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 F. AVENUE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607
Mailing Address - Country:US
Mailing Address - Phone:520-364-1429
Mailing Address - Fax:520-364-4261
Practice Address - Street 1:1100 F AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-1919
Practice Address - Country:US
Practice Address - Phone:520-364-1429
Practice Address - Fax:520-364-4261
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN028867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ428989Medicaid