MEDICARE: DR. C. DEAN HARTWIG M.D.

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	2084P0800X	Psychiatry Physician	C32784	CA

General Provider Information

NPI Number	:	1114937539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. C. DEAN HARTWIG M.D.

Provider Business Mailing Address
First Line	:	1961 LAS PLUMAS AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95133-1741
Country	:	US
Telephone Number	:	408-251-9300
Fax Number	:	408-251-9400

Provider Business Practice Location Address
First Line	:	1961 LAS PLUMAS AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95133-1741
Country	:	US
Telephone Number	:	408-251-9300
Fax Number	:	408-251-9400

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	11/06/2014

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