Provider Demographics
NPI:1972874436
Name:HARTLEY, JEFFREY ALLAN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLAN
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7802 POORMAN LN
Mailing Address - Street 2:
Mailing Address - City:PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:48755-9791
Mailing Address - Country:US
Mailing Address - Phone:317-222-8827
Mailing Address - Fax:
Practice Address - Street 1:7135 TWIN OAKS DR
Practice Address - Street 2:SUITE H
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-6847
Practice Address - Country:US
Practice Address - Phone:317-222-8827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle