Basic Information
Provider Information | |||||||||
NPI: | 1639174907 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HARDIN | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: | MICHAEL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5220 BELFORT RD | ||||||||
Address2: | STE 130 | ||||||||
City: | JACKSONVILLE | ||||||||
State: | FL | ||||||||
PostalCode: | 322566017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9044463451 | ||||||||
FaxNumber: | 9044463013 | ||||||||
Practice Location | |||||||||
Address1: | 9399 CROWN CREST BLVD | ||||||||
Address2: | SUITE 430 | ||||||||
City: | PARKER | ||||||||
State: | CO | ||||||||
PostalCode: | 801388506 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3032692310 | ||||||||
FaxNumber: | 9044463013 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/14/2005 | ||||||||
LastUpdateDate: | 01/16/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A82975 | CA | Y |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | MD29305 | OR | N |   | Allopathic & Osteopathic Physicians | Surgery |   |
No ID Information.