Provider Demographics
NPI:1558360164
Name:HARTMAN, ROBERT M (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:M
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6971
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0971
Mailing Address - Country:US
Mailing Address - Phone:818-907-7076
Mailing Address - Fax:402-434-6047
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:SUITE 329
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5246
Practice Address - Country:US
Practice Address - Phone:818-907-7076
Practice Address - Fax:818-907-7044
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52939207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G52939Medicaid
CAG52939Medicare ID - Type Unspecified
CA00G52939Medicaid