Provider Demographics
NPI:1093961328
Name:DAVID J. HART, M.D., INC.
Entity Type:Organization
Organization Name:DAVID J. HART, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:W
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-239-9834
Mailing Address - Street 1:2235 E FLAMINGO RD
Mailing Address - Street 2:# 201C
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5129
Mailing Address - Country:US
Mailing Address - Phone:937-239-9834
Mailing Address - Fax:
Practice Address - Street 1:13010 HESPERIA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5837
Practice Address - Country:US
Practice Address - Phone:937-239-9834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A3741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty