Provider Demographics
NPI:1184797110
Name:HARTZELL, TRISTAN LAYTON (MD)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:LAYTON
Last Name:HARTZELL
Suffix:
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 1:301 N 27TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4401
Mailing Address - Country:US
Mailing Address - Phone:402-844-8291
Mailing Address - Fax:402-844-8292
Practice Address - Street 1:301 N 27TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4401
Practice Address - Country:US
Practice Address - Phone:402-844-8291
Practice Address - Fax:402-844-8292
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26210207XS0106X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099588036OtherMEDICARE
NE20079OtherBCBS
NE10025561800Medicaid