Provider Demographics
NPI:1124106927
Name:HAMILTON, GRAHAM A (DPM)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:A
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:DPM
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 531968
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-1968
Mailing Address - Country:US
Mailing Address - Phone:833-887-4863
Mailing Address - Fax:
Practice Address - Street 1:3804 S JACKSON RD STE 1
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6681
Practice Address - Country:US
Practice Address - Phone:956-296-3001
Practice Address - Fax:956-296-3000
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3114213E00000X, 213ES0103X
CAE4101213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41010Medicaid
U69775Medicare UPIN
000E41010Medicare ID - Type Unspecified