Provider Demographics
NPI:1063403830
Name:HARTMAN, LAURA J (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 SPRING BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-7002
Mailing Address - Country:US
Mailing Address - Phone:541-543-3687
Mailing Address - Fax:425-795-9505
Practice Address - Street 1:4255 SPRING BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-7002
Practice Address - Country:US
Practice Address - Phone:541-543-3687
Practice Address - Fax:425-795-9505
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24065207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181646Medicaid
OR181646Medicaid
F56323Medicare UPIN