MEDICARE: SAMUEL CHRISTIAN HARTMAN MD

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	207Q00000X	Family Medicine Physician	K0487	TX

General Provider Information

NPI Number	:	1134107782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL CHRISTIAN HARTMAN MD

Provider Business Mailing Address
First Line	:	13725 NORTHWEST BLVD
Second Line	:	SUITE 230
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78410-5127
Country	:	US
Telephone Number	:	361-387-3616
Fax Number	:	361-387-3504

Provider Business Practice Location Address
First Line	:	13725 NORTHWEST BLVD
Second Line	:	SUITE 230
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78410-5127
Country	:	US
Telephone Number	:	361-387-3616
Fax Number	:	361-387-3504

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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