Basic Information
| Provider Information | |||||||||
| NPI: | 1518161736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDEY | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 BENT TREE TRL | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705087048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379844608 | ||||||||
| FaxNumber: | 3379843707 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 BENT TREE TRL | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705087048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379844608 | ||||||||
| FaxNumber: | 3379843707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 06/26/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0204X | 6779 | LA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02150 | 05 | LA | MEDICAID | 6779 | 01 | LA | PHYSICIAN | OTHER |