Provider Demographics
NPI:1497085476
Name:WALTER F HARTMAN MD PA
Entity Type:Organization
Organization Name:WALTER F HARTMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-288-2222
Mailing Address - Street 1:13725 NW BLVD
Mailing Address - Street 2:STE 230
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5127
Mailing Address - Country:US
Mailing Address - Phone:361-387-1624
Mailing Address - Fax:361-241-9605
Practice Address - Street 1:13725 NW BLVD
Practice Address - Street 2:STE 230
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5127
Practice Address - Country:US
Practice Address - Phone:361-387-1624
Practice Address - Fax:361-241-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J3744OtherBLUE CROSS
TX127175102Medicaid
TX127175102Medicaid
TX8J3744OtherBLUE CROSS
TX00E659Medicare Oscar/Certification