Provider Demographics
NPI:1912109166
Name:HARTSFIELD, PAUL FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:FREDERICK
Last Name:HARTSFIELD
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:P.O. BOX 12427
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317
Mailing Address - Country:US
Mailing Address - Phone:850-297-0114
Mailing Address - Fax:850-297-0314
Practice Address - Street 1:1843 FIDDLER CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4450
Practice Address - Country:US
Practice Address - Phone:850-878-5500
Practice Address - Fax:850-878-5522
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 102459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000611200Medicaid
FLCF313YMedicare PIN