Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 18018 | WV |
N | 208D00000X | General Practice Physician | 18018 | WV |
NPI | 1003912163 |
---|---|
Provider Name | Dr. Joseph Michael Hartzog |
First Address | Morgantown, WV 26508-7306 |
Second Address | Morgantown, WV 26508-7306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |