Roderic Joel Hartman, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

21315 Issued in AZ

Practice address

1896 E Babbitt Lane
San Luis, AZ 85349-1669

Phone

(928) 722-6112

Fax

(928) 722-6113

NPI assigned

Jun 17, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475452800000",
    "number": "1962607317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1669",
            "address_2": "1896 E BABBITT LANE",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853491669",
            "telephone_number": "928-722-6112",
            "fax_number": "928-722-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1896 E BABBITT LANE",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853491669",
            "telephone_number": "928-722-6112",
            "fax_number": "928-722-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARTMAN",
        "first_name": "RODERIC",
        "middle_name": "JOEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-17",
        "last_updated": "2016-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G87523",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "21315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "651170616",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "907349",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adrian Gutierrez, FNP-BC
• Christina Alyssa Gutierrez
• Veronica Guzman-Vincent, GUIDANCE COUNSELOR
• Nathaniel Spencer Harriman, M.S.S., PA-C
• Robin Harrison, PT
• Healing Together
• Sophia Hefner
• Hope Bilingual Speech and Feeding Therapy
• Martha Imelda Huizar, MS, RD, CLC
• Elvira Z. Ingram

• Pediatrics Physician in San Luis, AZ
• Providers in San Luis, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.