Provider Demographics
NPI:1811986490
Name:HAMILOS, DAVID THEODORE
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:THEODORE
Last Name:HAMILOS
Suffix:
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 1:508 PRINCETON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2060
Mailing Address - Country:US
Mailing Address - Phone:423-926-2741
Mailing Address - Fax:423-926-5782
Practice Address - Street 1:508 PRINCETON RD
Practice Address - Street 2:STE 202
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2063
Practice Address - Country:US
Practice Address - Phone:423-926-2741
Practice Address - Fax:423-926-5782
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000284213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN85440OtherBCBS OF TENNESSEE
TN3351538Medicaid
TN000284OtherTN PODIATRY LICENSE
TN3351538Medicaid
TN85440OtherBCBS OF TENNESSEE