Provider Demographics
NPI:1023070687
Name:HARTIN, RICHARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:HARTIN
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 1:2777 OWL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-5449
Mailing Address - Country:US
Mailing Address - Phone:512-569-8993
Mailing Address - Fax:
Practice Address - Street 1:ONE ST. MARK'S PLACE
Practice Address - Street 2:ST. MARK'S HOSPITAL
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1250
Practice Address - Country:US
Practice Address - Phone:979-242-2333
Practice Address - Fax:979-242-5171
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6524207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134102612Medicaid
TXP00375536OtherRAILROAD MEDICARE
TX134102612Medicaid
TX8J2404Medicare Oscar/Certification