MEDICARE: KENNETH R HART D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	F8504	TX
2	2083A0100X	Aerospace Medicine Physician	F8504	TX
3	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	F8504	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003998071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH R HART D.O.

Provider Business Mailing Address
First Line	:	2935 THOUSAND OAKS
Second Line	:	SUITE 294
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3312
Country	:	US
Telephone Number	:	210-494-1100
Fax Number	:	210-494-1117

Provider Business Practice Location Address
First Line	:	5101 MEDICAL DRIVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4801
Country	:	US
Telephone Number	:	210-592-5349
Fax Number	:	210-592-5462

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/16/2015

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Directions to “ KENNETH R HART D.O.” Practice Location

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