Basic Information
| Provider Information | |||||||||
| NPI: | 1174520944 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3178 | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524063178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193981583 | ||||||||
| FaxNumber: | 3193992085 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 10TH STREET SE | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524032404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193981545 | ||||||||
| FaxNumber: | 3193992039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 02/09/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 27079 | IA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1056770 | 05 | IA | MEDICAID | 56471 | 01 | IA | BLUE CROSS/BLUE SHIELD | OTHER |