Provider Demographics
NPI:1225032832
Name:HARTMAN, JOHN A (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 857
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3326
Mailing Address - Country:US
Mailing Address - Phone:573-756-6438
Mailing Address - Fax:573-756-6439
Practice Address - Street 1:1103 WEBER RD
Practice Address - Street 2:STE 101
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3326
Practice Address - Country:US
Practice Address - Phone:573-756-6438
Practice Address - Fax:573-756-6439
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5E40207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242382208Medicaid