Healthcare Provider Details

I. General information

NPI: 1578630687
Provider Name (Legal Business Name): JEFFREY E HARTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 S BERNARD ST
SPOKANE WA
99204-2511
US

IV. Provider business mailing address

521 S BERNARD ST
SPOKANE WA
99204-2511
US

V. Phone/Fax

Practice location:
  • Phone: 509-747-2147
  • Fax: 509-747-2148
Mailing address:
  • Phone: 509-747-2147
  • Fax: 509-747-2148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD00017491
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: