Healthcare Provider Details

I. General information

NPI: 1033122759
Provider Name (Legal Business Name): DENISE A HARDY DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9815 MACKENZIE RD
ST LOUIS MO
63123
US

IV. Provider business mailing address

7541 LOVELLA AVE
ST LOUIS MO
63117
US

V. Phone/Fax

Practice location:
  • Phone: 314-638-1590
  • Fax: 314-638-8788
Mailing address:
  • Phone: 314-638-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000752
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: