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Individual

DR. SHIRLEY FRED HARTLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
112 W PASADENA BLVD, DEER PARK, TX 77536-4870
(281) 479-5311
(281) 479-0748
Mailing address
112 W PASADENA BLVD, DEER PARK, TX 77536-4870
(281) 479-5311
(281) 479-0748

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0691
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10014888
AMERIGROUP NUMBER
TX
01
4250488
AETNA PROVIDER NUMBER
TX
01
82J977
BC/BS OF TEXAS
TX
Enumeration date
04/06/2006
Last updated
10/25/2007
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