Provider Demographics
NPI:1649208646
Name:HARTLEY, RONALD WINFIELD JR (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:WINFIELD
Last Name:HARTLEY
Suffix:JR
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 7643
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-0643
Mailing Address - Country:US
Mailing Address - Phone:970-663-2742
Mailing Address - Fax:970-667-0847
Practice Address - Street 1:2525 4TH ST
Practice Address - Street 2:STE 202
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3966
Practice Address - Country:US
Practice Address - Phone:303-443-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41210174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC499018Medicare PIN
COH82297Medicare UPIN