Provider Demographics
NPI:1750463378
Name:HARTWELL, ORAN C (PA)
Entity Type:Individual
Prefix:
First Name:ORAN
Middle Name:C
Last Name:HARTWELL
Suffix:
Gender:M
Credentials:PA
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 2550
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-2550
Mailing Address - Country:US
Mailing Address - Phone:214-227-2457
Mailing Address - Fax:214-764-0880
Practice Address - Street 1:1803 LOWELL CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6100
Practice Address - Country:US
Practice Address - Phone:281-344-1715
Practice Address - Fax:214-764-0880
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02791363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218589404Medicaid
TX218589403Medicaid
TX218589405Medicaid
TX218589401Medicaid
TX218589402Medicaid
TXP01074064OtherRAILROAD MEDICARE
TX218589401Medicaid
TX8C6466Medicare PIN
TXTXB146113Medicare PIN
TXTXB146114Medicare PIN
TXTXB146112Medicare PIN