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Individual
IVAN DEDRICK GAVIN HAMILTON
Active
Individual
IVAN DEDRICK GAVIN HAMILTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A104632
CA
207R00000X
Internal Medicine Physician
D63437
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669421202
—
CA
05
—
408417900
—
MD
01
—
AV608Z
MEDICARE PTAN
CA
Enumeration date
05/10/2006
Last updated
05/28/2021
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