Provider Demographics
NPI:1336189067
Name:HARTLEROAD, JAMES A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:HARTLEROAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16000 APPLE VALLEY RD STE C3
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-7815
Mailing Address - Country:US
Mailing Address - Phone:760-242-8900
Mailing Address - Fax:760-242-8994
Practice Address - Street 1:16000 APPLE VALLEY RD STE C3
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-7815
Practice Address - Country:US
Practice Address - Phone:760-242-8900
Practice Address - Fax:760-242-8994
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74901208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F46669Medicare UPIN
CA00G749010Medicare ID - Type Unspecified