Provider Demographics
NPI:1164182382
Name:HART, DONALD JEREMIAH
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JEREMIAH
Last Name:HART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6975 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6730
Mailing Address - Country:US
Mailing Address - Phone:817-201-3828
Mailing Address - Fax:
Practice Address - Street 1:6975 DEER RUN DR
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76137-6730
Practice Address - Country:US
Practice Address - Phone:817-201-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician