Provider Demographics
NPI:1568420784
Name:HARTIGAN, JOSEPH R (M D)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:HARTIGAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:BLDG 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:4203 BELFORT RD
Practice Address - Street 2:SUITE 215
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1416
Practice Address - Country:US
Practice Address - Phone:904-296-4141
Practice Address - Fax:904-279-2095
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65852208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLO20031821OtherRAILROAD MEDICARE
1498799OtherCIGNA
208157OtherAVMED
25316OtherBCBS FL
4479855OtherAETNA
25316YMedicare ID - Type Unspecified
FLO20031821OtherRAILROAD MEDICARE