Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | D9861 | OR |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DEN.00204638 | CO |
N | 204E00000X | Oral & Maxillofacial Surgeon | MD190558 | OR |
NPI | 1164712022 |
---|---|
Provider Name | Dr. Travis Jon Hamilton |
First Address | Denver, CO 80238-2300 |
Second Address | Denver, CO 80238-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2011 |
Last Update Date | 01/07/2021 |