Provider Demographics
NPI:1457356255
Name:HAMILTON, HAROLD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:BRUCE
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 1:205 WOODHEW DR
Mailing Address - Street 2:STE 200
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6689
Mailing Address - Country:US
Mailing Address - Phone:254-776-9775
Mailing Address - Fax:254-776-9751
Practice Address - Street 1:205 WOODHEW DR
Practice Address - Street 2:STE 200
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6689
Practice Address - Country:US
Practice Address - Phone:254-776-9775
Practice Address - Fax:254-776-9751
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1462207T00000X
LAMD020855207T00000X
CAA53187207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F23439OtherMEDICARE PTAN
P00788761OtherRAILROAD MEDICARE
TX0062CJOtherBLUE CROSS BLUE SHIELD
TX140005555OtherRAILROAD MEDICARE
TX8V8480OtherBLUECROSS BLUESHIELD
TX5292421OtherAETNA
8CF004OtherBCBS
TX114423102OtherFIRSTCARE
TX99670OtherSCOTT & WHITE
TXP00383121OtherRR MCR PTAN
TX029531302Medicaid
TX53403OtherBLUELINK
TX8V8480OtherBLUECROSS BLUESHIELD
TX140005555OtherRAILROAD MEDICARE
TX029531302Medicaid