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General NPI Number Information
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NPI Number | 1255503629
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Entity Type | Organization
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Legal Business Name | ROLAND HART MD INC
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 3031 W MARCH LN SUITE 336E
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City | STOCKTON
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State | CA
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Zip | 95219-6500
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Country | US
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Telephone | 209-957-3821
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Fax | 209-957-1179
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Provider Business Mailing Address
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Address Line | 3031 W MARCH LN SUITE 336E
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City | STOCKTON
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State | CA
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Zip | 95219-6500
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Country | US
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Telephone | 209-957-3821
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Fax | 209-957-1179
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROLAND HART
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Credential | MD
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Telephone | 209-957-3821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | C34191
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License Number State | CA
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