Healthcare Provider Details

I. General information

NPI: 1114901303
Provider Name (Legal Business Name): PAT C HARDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 STOCKTON BLVD DEPARTMENT OF PEDIATRICS 3RD FLOOR
SACRAMENTO CA
95817-2208
US

IV. Provider business mailing address

2516 STOCKTON BLVD DEPARTMENT OF PEDIATRICS 3RD FLOOR
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2781
  • Fax: 916-451-3014
Mailing address:
  • Phone: 916-734-2781
  • Fax: 916-451-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberA23188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: