MEDICARE: DR. JOHN SHERMAN HARDY JR. M.D.

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	207K00000X	Allergy & Immunology Physician	MD00036114	WA
2	207R00000X	Internal Medicine Physician	MD00036114	WA

General Provider Information

NPI Number	:	1144547662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN SHERMAN HARDY JR. M.D.

Provider Business Mailing Address
First Line	:	7153 SEAWITCH LN NW
Second Line	:
City	:	SEABECK
State	:	WA
Zip	:	98380-9593
Country	:	US
Telephone Number	:	360-830-9364
Fax Number	:	360-830-3341

Provider Business Practice Location Address
First Line	:	7153 SEAWITCH LN NW
Second Line	:
City	:	SEABECK
State	:	WA
Zip	:	98380-9593
Country	:	US
Telephone Number	:	360-830-9364
Fax Number	:	360-830-3341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	04/23/2010

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