Healthcare Provider Details

I. General information

NPI: 1932273604
Provider Name (Legal Business Name): TW HARD MD AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 W MARCH LN STE 200
STOCKTON CA
95219-2369
US

IV. Provider business mailing address

3325 CHANATE RD
SANTA ROSA CA
95404-1707
US

V. Phone/Fax

Practice location:
  • Phone: 209-473-6555
  • Fax: 209-473-6543
Mailing address:
  • Phone: 707-523-7222
  • Fax: 707-578-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberC31017
License Number StateCA

VIII. Authorized Official

Name: EDWARD 'TED' W HARD
Title or Position: CEO
Credential: M.D.
Phone: 707-523-7222