Provider Demographics
NPI:1396765038
Name:HAMILTON, WILLIAM CLAUDE (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLAUDE
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 1:1700 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3317
Mailing Address - Country:US
Mailing Address - Phone:541-506-6424
Mailing Address - Fax:541-296-7650
Practice Address - Street 1:1700 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3317
Practice Address - Country:US
Practice Address - Phone:541-506-6424
Practice Address - Fax:541-296-7650
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14571208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1035179Medicaid
OR165522Medicaid
WA1035179Medicaid
WA8853806Medicare PIN
330001983Medicare PIN
OR134975Medicare PIN
OR00WCJJFBMedicare PIN
OR165522Medicaid