Healthcare Provider Details

I. General information

NPI: 1457357642
Provider Name (Legal Business Name): ROY ALDEN HART DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HICKMAN ROAD BROADLAWNS MEDICAL CENTER
DES MOINES IA
50314
US

IV. Provider business mailing address

1801 HICKMAN ROAD BROADLAWNS MEDICAL CENTER
DES MOINES IA
50314
US

V. Phone/Fax

Practice location:
  • Phone: 515-282-2548
  • Fax:
Mailing address:
  • Phone: 515-282-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036081158
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5315029112
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: