Individual
DR. DERRICK JACK HAMILTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1484 LAKESIDE DRIVE, JACKSON, KY 41339-6555
(606) 666-9950
(606) 666-9136
Mailing address
PO BOX 690, BEATTYVILLE, KY 41311-0690
(606) 464-0151
(606) 464-0152
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02998
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407818628
MEDICIAID FQHC GROUP LEE
KY
01
—
1467417691
MEDICAID FQHC GROUP JACKSON
KY
01
—
1962823393
MEDICIAID FQHC GROUP WOLFE
KY
05
—
7100015160
—
KY
Enumeration date
10/10/2006
Last updated
03/13/2020
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