Individual
DR. RODERIC JOEL HARTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1896 E BABBITT LANE, SAN LUIS, AZ 85349-1669
(928) 722-6112
(928) 722-6113
Mailing address
PO BOX 1669, 1896 E BABBITT LANE, SAN LUIS, AZ 85349-1669
(928) 722-6112
(928) 722-6113
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
21315
AZ
208000000X
Pediatrics Physician
G87523
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
651170616
TAX ID
AZ
05
—
907349
—
AZ
Enumeration date
06/17/2007
Last updated
10/03/2016
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