Healthcare Provider Details

I. General information

NPI: 1932178829
Provider Name (Legal Business Name): DOUGLAS J HATLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CLINIC DR
MADISONVILLE KY
42431-1661
US

IV. Provider business mailing address

PO BOX 3407
EVANSVILLE IN
47733-3407
US

V. Phone/Fax

Practice location:
  • Phone: 270-825-6680
  • Fax: 270-825-7266
Mailing address:
  • Phone: 812-436-7280
  • Fax: 812-436-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number01039937A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number26004
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: