Healthcare Provider Details

I. General information

NPI: 1316071616
Provider Name (Legal Business Name): HANS-DAVID ROBERT HARTWIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRUDENTIAL DR SUITE 713
JACKSONVILLE FL
32207-8210
US

IV. Provider business mailing address

820 PRUDENTIAL DR SUITE 713
JACKSONVILLE FL
32207-8210
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-5682
  • Fax:
Mailing address:
  • Phone: 904-396-5682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL 29095
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME113088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: