MEDICARE: DR. JOSEPH R. HARTIGAN 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	208600000X	Surgery Physician	ME65852	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	O20031821	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	1498799	OTHER	CIGNA
3	208157	OTHER	AVMED
4	25316	OTHER	BCBS FL
5	4479855	OTHER	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568420784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH R. HARTIGAN M. D.

Provider Business Mailing Address
First Line	:	11945 SAN JOSE BLVD
Second Line	:	BLDG 300
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-396-1725
Fax Number	:	904-399-1717

Provider Business Practice Location Address
First Line	:	4203 BELFORT RD
Second Line	:	SUITE 215
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1416
Country	:	US
Telephone Number	:	904-296-4141
Fax Number	:	904-279-2095

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/22/2011

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