Individual
JEFFREY GLEN HART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11050 MOUNT BELVEDERE BLVD, USA MEDDAC/CREDENTIALS, FORT DRUM, NY 13602-5438
(315) 772-4025
(315) 772-9498
Mailing address
11050 MOUNT BELVEDERE BLVD, USA MEDDAC/CREDENTIALS, FORT DRUM, NY 13602-5438
(315) 772-4025
(315) 772-9498
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50-000688
OH
Other
Enumeration date
11/29/2005
Last updated
07/08/2007
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