Provider Demographics
NPI:1891730818
Name:HARTZOG, CARL W (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:W
Last Name:HARTZOG
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 1:100 MEDICAL CENTER DR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1130
Mailing Address - Country:US
Mailing Address - Phone:256-492-8590
Mailing Address - Fax:256-492-8590
Practice Address - Street 1:100 MEDICAL CENTER DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1130
Practice Address - Country:US
Practice Address - Phone:256-492-8590
Practice Address - Fax:256-492-4498
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL6015207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000002477Medicaid
AL2477Medicaid
AL51002477OtherBCBS AL
000002477Medicare ID - Type Unspecified
AL51002477OtherBCBS AL
AL000002477Medicaid