Provider Demographics
NPI:1003962622
Name:HARTSHORN, CODY J (MD)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:J
Last Name:HARTSHORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 PALUXY RD STE 3000
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5655
Mailing Address - Country:US
Mailing Address - Phone:817-578-3910
Mailing Address - Fax:
Practice Address - Street 1:1310B PALUXY ROAD
Practice Address - Street 2:SUITE 3000
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5655
Practice Address - Country:US
Practice Address - Phone:817-578-3910
Practice Address - Fax:817-578-3909
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-43940390200000X
TXN6346207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program