Individual
KENT LEROY HAMILTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
683 E 3RD ST, WEISER, ID 83672-2248
(208) 549-0211
(208) 549-0104
Mailing address
PO BOX 871, WEISER, ID 83672-0871
(208) 549-0211
(208) 549-0104
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
RPA-149
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004369700
—
ID
Enumeration date
10/04/2006
Last updated
12/08/2008
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