Provider Demographics
NPI:1003479783
Name:HART, TROY WILLIAM
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:WILLIAM
Last Name:HART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3042
Mailing Address - Country:US
Mailing Address - Phone:541-272-3740
Mailing Address - Fax:541-272-3740
Practice Address - Street 1:137 NE 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3042
Practice Address - Country:US
Practice Address - Phone:541-272-3740
Practice Address - Fax:541-272-3740
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist