Provider Demographics
NPI:1306802731
Name:FISH, HAMILTON R (MD)
Entity type:Individual
Prefix:DR
First Name:HAMILTON
Middle Name:R
Last Name:FISH
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 1:32735 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3900
Mailing Address - Country:US
Mailing Address - Phone:352-728-3111
Mailing Address - Fax:352-728-3201
Practice Address - Street 1:32735 RADIO RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3900
Practice Address - Country:US
Practice Address - Phone:352-728-3111
Practice Address - Fax:352-728-3201
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0031495174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57051Medicare UPIN
FL59269Medicare ID - Type Unspecified