Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 105393 | MN |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 54124 | MN |
N | 207YS0123X | Facial Plastic Surgeon | 36295 | IA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 36295 | IA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 36295 | IA |
NPI | 1841273281 |
---|---|
Provider Name | Grant S Hamilton III |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 14/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I22460 | (02) |