Healthcare Provider Details

I. General information

NPI: 1619032182
Provider Name (Legal Business Name): JOHN TUCKER HARDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N GRAND AVE
PUEBLO CO
81003-2867
US

IV. Provider business mailing address

1115 N GRAND AVE
PUEBLO CO
81003-2867
US

V. Phone/Fax

Practice location:
  • Phone: 719-583-4232
  • Fax: 719-562-4415
Mailing address:
  • Phone: 719-583-4232
  • Fax: 719-562-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30618
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number30618
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number30618
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: