Healthcare Provider Details

I. General information

NPI: 1386641710
Provider Name (Legal Business Name): GREGORY THOMAS HARDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8141 S EMERSON AVE SUITE A
INDIANAPOLIS IN
46237-8560
US

IV. Provider business mailing address

8141 S EMERSON AVE SUITE A
INDIANAPOLIS IN
46237-8560
US

V. Phone/Fax

Practice location:
  • Phone: 317-888-1051
  • Fax: 317-888-1591
Mailing address:
  • Phone: 317-888-1051
  • Fax: 317-888-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01036081A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: