Healthcare Provider Details

I. General information

NPI: 1174265193
Provider Name (Legal Business Name): DAVID LAYNE HARDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 BELLWEST BLVD
BELLEVILLE WI
53508-9433
US

IV. Provider business mailing address

1121 BELLWEST BLVD
BELLEVILLE WI
53508-9433
US

V. Phone/Fax

Practice location:
  • Phone: 608-424-3384
  • Fax: 608-424-6353
Mailing address:
  • Phone: 608-424-3384
  • Fax: 608-424-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number82903
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82903-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number82903-20
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: