Provider Demographics
NPI:1104834027
Name:HARTMAN, JOHN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:HARTMAN
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 1:1600 BUDINGER AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6005
Mailing Address - Country:US
Mailing Address - Phone:407-892-3387
Mailing Address - Fax:407-892-7297
Practice Address - Street 1:1300 KEVSTIN DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5843
Practice Address - Country:US
Practice Address - Phone:321-442-1214
Practice Address - Fax:321-442-1215
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45232700Medicaid
D67333Medicare UPIN
FL79696XMedicare ID - Type Unspecified