Provider Demographics
NPI:1295936292
Name:HAMLIN, GARY WARREN (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:WARREN
Last Name:HAMLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64802-1300
Mailing Address - Country:US
Mailing Address - Phone:417-781-4250
Mailing Address - Fax:417-781-5544
Practice Address - Street 1:101 N RANGE LINE RD
Practice Address - Street 2:NORTHPARK MALL STE 246
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-4118
Practice Address - Country:US
Practice Address - Phone:417-781-4250
Practice Address - Fax:417-781-5544
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34816207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1009OtherACOEP BOARD CERTIFIED
2134OtherNBEOPS BOARD CERTIFIED
MO32246OtherBNDD
MO34816OtherLICENSE NO.
7850OtherACOFP BOARD CERTIFIED
BH1829285OtherDEA
E45177Medicare UPIN