Basic Information
| Provider Information | |||||||||
| NPI: | 1043401102 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDWARD W. HARTZLER, MD, INC, PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 84921 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981246221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064392988 | ||||||||
| FaxNumber: | 2064313939 | ||||||||
| Practice Location | |||||||||
| Address1: | 16110 8TH AVE SW | ||||||||
| Address2: | SUITE A-3 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981662962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062442422 | ||||||||
| FaxNumber: | 2063045034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 05/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | HARTZLER | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 20624222422 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00013292 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.