Provider Demographics
NPI:1972091940
Name:HAMILTON, DANIEL (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4946 W ELECTRA LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-3839
Mailing Address - Country:US
Mailing Address - Phone:602-614-4295
Mailing Address - Fax:
Practice Address - Street 1:4946 W ELECTRA LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310
Practice Address - Country:US
Practice Address - Phone:602-614-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7058363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant