Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 2015030821 | MO |
N | 208000000X | Pediatrician | 2015030821 | MO |
Y | 2080P0204X | Pediatric Emergency Doctor | 60758 | AZ |
NPI | 1508125295 |
---|---|
Provider Name | Neal Russell Hartman |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2012 |
Last Update Date | 12/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006541 | (05) | AZ |