Provider Demographics
NPI:1578632725
Name:HART, JEFF D (MD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:D
Last Name:HART
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:33515 10TH PL S STE 16
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7300
Mailing Address - Country:US
Mailing Address - Phone:253-838-2326
Mailing Address - Fax:253-838-5781
Practice Address - Street 1:33515 10TH PL S STE 16
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7300
Practice Address - Country:US
Practice Address - Phone:253-838-2326
Practice Address - Fax:253-838-5781
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000225972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA05985Medicare UPIN