Provider Demographics
NPI:1457587289
Name:HARTL, RICHARD W (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:HARTL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 WINTER HAWK CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1402
Mailing Address - Country:US
Mailing Address - Phone:719-594-0926
Mailing Address - Fax:
Practice Address - Street 1:15854 JACKSON CREEK PKWY
Practice Address - Street 2:120
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8662
Practice Address - Country:US
Practice Address - Phone:719-481-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23961207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine