Provider Demographics
NPI:1821180738
Name:HARTY, JAMES I (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:I
Last Name:HARTY
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 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-4480
Mailing Address - Fax:270-688-4489
Practice Address - Street 1:1301 PLEASANT VALLEY RD
Practice Address - Street 2:SUITE 302
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9774
Practice Address - Country:US
Practice Address - Phone:270-688-4480
Practice Address - Fax:270-688-4489
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19155208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100008790Medicaid
KY64191554Medicaid
KYK194930Medicare PIN
IN100008790Medicaid
IN100008790OtherMEDICAID IN
KY0998209Medicare PIN