MEDICARE: DAVID HARDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	308	NE
2	207Q00000X	Family Medicine Physician	308	NE

General Provider Information

NPI Number	:	1518928407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID HARDY

Provider Business Mailing Address
First Line	:	BUILDING 3334
Second Line	:
City	:	TINKER AIR FORCE BASE
State	:	OK
Zip	:	73118
Country	:	US
Telephone Number	:	405-734-2778
Fax Number	:

Provider Business Practice Location Address
First Line	:	BUILDING 3334
Second Line	:
City	:	TINKER AIR FORCE BASE
State	:	OK
Zip	:	73118
Country	:	US
Telephone Number	:	405-734-2778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	12/23/2022

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