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General NPI Number Information
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NPI Number | 1700872934
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Entity Type | Individual
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Provider Name | JOHN CALVIN HARDIN III MD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 1801 FAIRFIELD AVE #105
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City | SHREVEPORT
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State | LA
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Zip | 71101-4443
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Country | US
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Telephone | 318-424-2192
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Fax | 318-424-2595
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Provider Business Mailing Address
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Address Line | 1801 FAIRFIELD AVE #105
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City | SHREVEPORT
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State | LA
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Zip | 71101-4443
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Country | US
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Telephone | 318-424-2192
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Fax | 318-484-2595
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 061835
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License Number State | LA
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