Basic Information
Provider Information
NPI: 1972710895
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARTT
FirstName: GREGORY
MiddleName: THOMAS
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2100 POWELL ST
Address2: SUITE 900
City: EMERYVILLE
State: CA
PostalCode: 946081826
CountryCode: US
TelephoneNumber: 5103502673
FaxNumber:  
Practice Location
Address1: 2175 ROSALINE AVE
Address2:  
City: REDDING
State: CA
PostalCode: 960012509
CountryCode: US
TelephoneNumber: 5302256000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/17/2007
LastUpdateDate: 10/12/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XA98062CAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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