Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | LL 29095 | SC |
Y | 2080P0204X | Pediatric Emergency Doctor | ME113088 | FL |
NPI | 1316071616 |
---|---|
Provider Name | Hans-David Robert Hartwig |
First Address | Jacksonville, FL 32207-8210 |
Second Address | Jacksonville, FL 32207-8210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 09/07/2012 |