Healthcare Provider Details

I. General information

NPI: 1740327642
Provider Name (Legal Business Name): KENNETH R HART DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 NAVARRO ST SUITE 502
SAN ANTONIO TX
78205-2516
US

IV. Provider business mailing address

6800 PARK TEN BLVD SUITE 266-S
SAN ANTONIO TX
78213-4211
US

V. Phone/Fax

Practice location:
  • Phone: 210-223-1145
  • Fax: 210-615-7619
Mailing address:
  • Phone: 210-732-7030
  • Fax: 210-732-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberF8504
License Number StateTX

VIII. Authorized Official

Name: DR. KENNETH RALPH HART
Title or Position: PRESIDENT AND MEDICAL DIRECTOR
Credential: D.O.
Phone: 210-732-7030