Provider Demographics
NPI:1811976509
Name:HARTMAN, RAYMOND P (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:P
Last Name:HARTMAN
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:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72833-1690
Mailing Address - Country:US
Mailing Address - Phone:479-495-5550
Mailing Address - Fax:
Practice Address - Street 1:4 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4510
Practice Address - Country:US
Practice Address - Phone:501-977-2200
Practice Address - Fax:501-977-2398
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0669207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129826001Medicaid
AR5K220OtherBLUECROSS BLUESHIELD
AR129826001Medicaid
AR5K220OtherBLUECROSS BLUESHIELD