Provider Demographics
NPI:1609809748
Name:HARTZLER, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:HARTZLER
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:PO BOX 34935
Mailing Address - Street 2:DEPT # 435
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1935
Mailing Address - Country:US
Mailing Address - Phone:206-439-4880
Mailing Address - Fax:206-431-3939
Practice Address - Street 1:16233 SYLVESTER RD SW
Practice Address - Street 2:SUITE 210
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3045
Practice Address - Country:US
Practice Address - Phone:206-244-2422
Practice Address - Fax:206-304-5034
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA66170Medicare UPIN