Provider Demographics
NPI:1750390746
Name:HARTMAN, GREGORY DWIGHT (DPM)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DWIGHT
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3008 SILLECT AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-6360
Mailing Address - Country:US
Mailing Address - Phone:661-398-3658
Mailing Address - Fax:661-398-3684
Practice Address - Street 1:3501 STOCKDALE HWY STE F
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2150
Practice Address - Country:US
Practice Address - Phone:661-398-3658
Practice Address - Fax:661-398-3684
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE002948213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU99672Medicare UPIN