Healthcare Provider Details

I. General information

NPI: 1750455788
Provider Name (Legal Business Name): RICHARD HARTMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N CLYDE MORRIS BLVD STE 200 HALIFAX FAMILY HEALTH CENTER
DAYTONA BEACH FL
32114-2765
US

IV. Provider business mailing address

201 N CLYDE MORRIS BLVD STE 200 HALIFAX FAMILY HEALTH CENTER
DAYTONA BEACH FL
32114-2765
US

V. Phone/Fax

Practice location:
  • Phone: 386-254-4165
  • Fax: 386-258-4891
Mailing address:
  • Phone: 386-254-4165
  • Fax: 386-258-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME40753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: