Provider Demographics
NPI:1437209996
Name:HART, RALPH WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:WILLIAM
Last Name:HART
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 1:735 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4741
Mailing Address - Country:US
Mailing Address - Phone:303-417-1445
Mailing Address - Fax:303-417-1445
Practice Address - Street 1:1000 W SOUTH BOULDER RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2752
Practice Address - Country:US
Practice Address - Phone:303-666-4357
Practice Address - Fax:303-604-5058
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32745207P00000X, 207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01327451Medicaid
CO483168OtherPIN
COR9858Medicare ID - Type Unspecified
CO01327451Medicaid