Healthcare Provider Details

I. General information

NPI: 1497723290
Provider Name (Legal Business Name): MICHAEL O'CONNOR HARDING D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 PENNSYLVANIA AVE
FORT WORTH TX
76104-2224
US

IV. Provider business mailing address

PO BOX 518
ARDMORE OK
73402-0518
US

V. Phone/Fax

Practice location:
  • Phone: 817-321-0312
  • Fax: 817-317-7033
Mailing address:
  • Phone: 580-220-6687
  • Fax: 580-223-6285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberL1602
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberL1602
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: