Provider Demographics
NPI:1588669410
Name:HARTMAN, DONALD DAVID SR (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DAVID
Last Name:HARTMAN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6565 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8737
Mailing Address - Country:US
Mailing Address - Phone:208-377-5055
Mailing Address - Fax:208-377-5335
Practice Address - Street 1:1907 S BROADWAY AVE STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-4229
Practice Address - Country:US
Practice Address - Phone:208-453-1222
Practice Address - Fax:208-345-1261
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2018-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM5688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003740800Medicaid
ID003740800Medicaid
ID1129030Medicare PIN