Healthcare Provider Details

I. General information

NPI: 1851180160
Provider Name (Legal Business Name): MALCOM C HARDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 SPRING RIDGE DR
MURPHY TX
75094-4266
US

IV. Provider business mailing address

104 SPRING RIDGE DR
MURPHY TX
75094-4266
US

V. Phone/Fax

Practice location:
  • Phone: 469-366-1976
  • Fax: 214-458-2683
Mailing address:
  • Phone: 469-366-1976
  • Fax: 214-458-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: