Provider Demographics
NPI:1174883607
Name:HAMLIN, JUSTIN KEITH (DO)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:KEITH
Last Name:HAMLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W DAUGHERTY ST
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-1717
Mailing Address - Country:US
Mailing Address - Phone:417-717-2017
Mailing Address - Fax:417-717-2134
Practice Address - Street 1:1001 W DAUGHERTY ST
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-1717
Practice Address - Country:US
Practice Address - Phone:417-717-2017
Practice Address - Fax:417-717-2134
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5469207Q00000X, 207QB0002X, 207RH0005X
KS05-38357207Q00000X, 207QB0002X, 207RH0005X
MO2013030301207QB0002X, 207RH0005X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS05-38357OtherKANSAS STATE BOARD OF HEALING ARTS
MO2013030301OtherMISSOURI BOARD OF HEALING ARTS
MO268648OtherMEDICARE GROUP NUMBER
OK5469OtherOKLAHOMA BOARD OF OSTEOPATHIC EXAMINERS
MO000050010OtherMEDICARE GROUP PTAN