Provider Demographics
NPI:1144218900
Name:AUBREY CHAD HARTMANN, MD, PA
Entity Type:Organization
Organization Name:AUBREY CHAD HARTMANN, MD, PA
Other - Org Name:LONE STAR DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:HARTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-260-5860
Mailing Address - Street 1:1401 MEDICAL PKWY
Mailing Address - Street 2:BUILDING B, SUITE 300
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7464
Mailing Address - Country:US
Mailing Address - Phone:512-260-5860
Mailing Address - Fax:512-260-5859
Practice Address - Street 1:1401 MEDICAL PKWY
Practice Address - Street 2:BUILDING B, SUITE 300
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7464
Practice Address - Country:US
Practice Address - Phone:512-260-5860
Practice Address - Fax:512-260-5859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00303UMedicare ID - Type Unspecified