Provider Demographics
NPI:1043401102
Name:EDWARD W. HARTZLER, MD, INC, PS
Entity Type:Organization
Organization Name:EDWARD W. HARTZLER, MD, INC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARTZLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:2062-422-2422
Mailing Address - Street 1:PO BOX 84921
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6221
Mailing Address - Country:US
Mailing Address - Phone:206-439-2988
Mailing Address - Fax:206-431-3939
Practice Address - Street 1:16110 8TH AVE SW
Practice Address - Street 2:SUITE A-3
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2962
Practice Address - Country:US
Practice Address - Phone:206-244-2422
Practice Address - Fax:206-304-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty