Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 19781 | WI |
N | 111NI0900X | Internist | 19781 | WI |
N | 207RA0401X | Internist - Addiction Medicine | 19781 | WI |
NPI | 1720188931 |
---|---|
Provider Name | Gurdon H Hamilton |
First Address | Marshfield, WI 54449-5777 |
Second Address | Marshfield, WI 54449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31245000 | (05) | WI |
B53363 | (02) |