Healthcare Provider Details

I. General information

NPI: 1770571721
Provider Name (Legal Business Name): SCOTT H HARDEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 LANDMARK PARKWAY DR SUITE 201
SAINT LOUIS MO
63127-1665
US

IV. Provider business mailing address

PO BOX 790379
SAINT LOUIS MO
63179-0379
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-3828
  • Fax: 314-843-3052
Mailing address:
  • Phone: 314-843-3828
  • Fax: 314-843-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number108376
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: