Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 6696 | FL |
NPI | 1750458378 |
---|---|
Provider Name | Dr. J Edward Hartley |
First Address | Saint Augustine, FL 32084-5720 |
Second Address | Saint Augustine, FL 32084-5720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 28/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
380921800 | (05) | FL |
593375448 | TAX ID (01) | FL |
U40471 | (02) | FL |