Healthcare Provider Details

I. General information

NPI: 1184698292
Provider Name (Legal Business Name): CHRISTOPHER GARETH HARDY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 HOYT AVE
EVERETT WA
98201-4972
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-5489
  • Fax: 425-317-3689
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberOP60270919
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: