Healthcare Provider Details

I. General information

NPI: 1881039386
Provider Name (Legal Business Name): HASKELL DAVID HARDY III DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 RANCH EST
LAURENS SC
29360-6208
US

IV. Provider business mailing address

PO BOX 182
LAURENS SC
29360-0182
US

V. Phone/Fax

Practice location:
  • Phone: 864-200-1047
  • Fax: 864-682-2898
Mailing address:
  • Phone: 864-200-1047
  • Fax: 864-682-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number2248
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: