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General NPI Number Information
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NPI Number | 1033366273
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Entity Type | Organization
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Legal Business Name | BRUCE A HARTWIG MD PA
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 09/12/2008
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Provider Practice Location Address
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Address Line | 3 SHIRCLIFF WAY SUITE 752
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4730
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Country | US
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Telephone | 904-389-6226
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Fax | 904-388-7265
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Provider Business Mailing Address
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Address Line | 3 SHIRCLIFF WAY SUITE 752
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4730
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Country | US
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Telephone | 904-389-6226
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Fax | 904-388-7265
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. BRUCE ALLAN HARTWIG
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Credential | MD
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Telephone | 904-389-6226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0039317
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License Number State | FL
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