Active NPI
Laurence Wilbur Hartley, MD
- Gynecology Physician
- Ukiah, CA
National Provider Identifier
1083647226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- A25739
- Practice address
- 1165 S Dora St
Suite G 2
Ukiah, CA 95482-8325 - Phone
- (707) 463-5535
- Fax
- (707) 463-0591
- NPI assigned
- Jul 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | A25739 | CA | Primary |
Addresses
Primary practice location
1165 S Dora St
Suite G 2
Ukiah, CA 95482-8325
Mailing address
1165 S Dora St
Suite G 2
Ukiah, CA 95482-8325
Phone (707) 463-5535
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A257391 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25739 | CA | MD | Chiropractor |
| A25739 | CA | MD | Gynecology Physician |
Interoperability endpoints
- lhartley335484@direct.ochin.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083647226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1165 S DORA ST",
"address_2": "SUITE G 2",
"city": "UKIAH",
"state": "CA",
"postal_code": "954828325",
"telephone_number": "707-463-5535",
"fax_number": "707-463-0591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1165 S DORA ST",
"address_2": "SUITE G 2",
"city": "UKIAH",
"state": "CA",
"postal_code": "954828325",
"telephone_number": "707-463-5535",
"fax_number": "707-463-0591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARTLEY",
"first_name": "LAURENCE",
"middle_name": "WILBUR",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "CA",
"license": "A25739",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A257391",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ukiah, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.