Provider Demographics
NPI:1013990548
Name:HARTLEY, BARBARA H (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:H
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-6437
Mailing Address - Country:US
Mailing Address - Phone:520-586-2945
Mailing Address - Fax:520-586-2993
Practice Address - Street 1:860 W 4TH ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6437
Practice Address - Country:US
Practice Address - Phone:520-586-2945
Practice Address - Fax:520-586-2993
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ469181Medicaid
AZG97263Medicare UPIN
AZZ29436Medicare ID - Type Unspecified