MEDICARE: LESLIE C. HARDICK DO, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1114185212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE C. HARDICK DO, PA

Provider Business Mailing Address
First Line	:	1325 PENNSYLVANIA AVE STE 690
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2133
Country	:	US
Telephone Number	:	817-924-2216
Fax Number	:	817-924-5602

Provider Business Practice Location Address
First Line	:	1325 PENNSYLVANIA AVE STE 690
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2133
Country	:	US
Telephone Number	:	817-924-2216
Fax Number	:	817-924-5602

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LESLIE CHRISTINE HARDICK
Credential	:	D.O.
Telephone Number	:	817-924-2216

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	04/01/2019

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