Provider Demographics
NPI:1609985530
Name:HARTLIEB, DONALD CARSON (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CARSON
Last Name:HARTLIEB
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 1:31 CHALET HILLS TER
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6697
Mailing Address - Country:US
Mailing Address - Phone:702-275-6767
Mailing Address - Fax:702-796-6310
Practice Address - Street 1:10521 JEFFREYS ST
Practice Address - Street 2:SUITE 220
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4180
Practice Address - Country:US
Practice Address - Phone:702-733-8871
Practice Address - Fax:702-733-2177
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5104174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002564Medicaid
NV002002564Medicaid