Provider Demographics
NPI:1730197450
Name:HAMILTON, RITA GLYNN (DO)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:GLYNN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1520
Mailing Address - Country:US
Mailing Address - Phone:214-820-9637
Mailing Address - Fax:214-820-9339
Practice Address - Street 1:909 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1520
Practice Address - Country:US
Practice Address - Phone:214-820-9637
Practice Address - Fax:214-820-9339
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0805208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047993301Medicaid
TX8BR093OtherBCBS
TXG31732Medicare UPIN
TX250013229Medicare PIN
TX047993301Medicaid
TXP00834559Medicare PIN
TX89X645Medicare PIN
TX8L3913Medicare PIN
TX89042FMedicare PIN