Healthcare Provider Details

I. General information

NPI: 1578632279
Provider Name (Legal Business Name): JAMES PATRICK HARDY MB BS BSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SALT LND
BEL TIBURON CA
94920
US

IV. Provider business mailing address

18 SALT LND
BEL TIBURON CA
94920
US

V. Phone/Fax

Practice location:
  • Phone: 617-412-1152
  • Fax:
Mailing address:
  • Phone: 617-412-1152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number225859
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA141159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: