Provider Demographics
NPI:1578630687
Name:HARTMAN, JEFFREY E (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:E
Last Name:HARTMAN
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 1:521 S BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2511
Mailing Address - Country:US
Mailing Address - Phone:509-747-2147
Mailing Address - Fax:509-747-2148
Practice Address - Street 1:521 S BERNARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2511
Practice Address - Country:US
Practice Address - Phone:509-747-2147
Practice Address - Fax:509-747-2148
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017491207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911221296 99204OtherTRICARE
WAHARJE06497OtherPREMERA BLUE CROSS
ID000010002928OtherREGENCE BS IDAHO
WA1134006Medicaid
WA0213795OtherLABOR AND INDUSTRIES
ID000010002928OtherREGENCE BS IDAHO
WAHARJE06497OtherPREMERA BLUE CROSS