Healthcare Provider Details

I. General information

NPI: 1912234576
Provider Name (Legal Business Name): JOHN PAUL HARTMAN NMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13180 E COLOSSAL CAVE RD STE 140
VAIL AZ
85641-9794
US

IV. Provider business mailing address

14281 E PLACITA LAGO VERDE
VAIL AZ
85641-0180
US

V. Phone/Fax

Practice location:
  • Phone: 928-812-2152
  • Fax:
Mailing address:
  • Phone: 928-812-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number94-457
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: