Provider Demographics
NPI:1487640074
Name:HARTZ, ARTHUR J (MD)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:J
Last Name:HARTZ
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 1:7450 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4048
Mailing Address - Country:US
Mailing Address - Phone:314-769-9247
Mailing Address - Fax:
Practice Address - Street 1:7450 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4048
Practice Address - Country:US
Practice Address - Phone:314-769-9247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6801016-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA47820OtherWELLMARK BCBS
H18688Medicare UPIN
IA47820Medicare ID - Type Unspecified