Healthcare Provider Details

I. General information

NPI: 1558349860
Provider Name (Legal Business Name): WARREN DALE HARDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD SUITE A107
MOBILE AL
36608-6774
US

IV. Provider business mailing address

PO BOX 36258
BELFAST ME
04915-1204
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-8572
  • Fax: 251-435-8615
Mailing address:
  • Phone: 251-243-4511
  • Fax: 251-405-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number16613
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number14085
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number16613
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: