Provider Demographics
NPI:1952347650
Name:HAMILTON, JENNIFER O (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:O
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:525 NW 2ND ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6487
Mailing Address - Country:US
Mailing Address - Phone:541-730-4400
Mailing Address - Fax:541-393-2075
Practice Address - Street 1:525 NW 2ND ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6487
Practice Address - Country:US
Practice Address - Phone:541-730-4400
Practice Address - Fax:541-393-2075
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD261182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORI05870Medicare UPIN