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NPI Code Detail

MEDICARE: CHARLES LYNN HARDISON MD

MEDICARE: CHARLES LYNN HARDISON MD
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
1207Q00000XFamily Medicine PhysicianG70382CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G70382OTHERCAMEDICAL LICENSE

General Provider Information

NPI Number : 1538475793
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES LYNN HARDISON MD
Provider Business Mailing Address
First Line : 120 CRAVEN RD STE 201
Second Line :
City : SAN MARCOS
State : CA
Zip : 92078-4237
Country : US
Telephone Number : 760-291-6650
Fax Number : 858-618-1523
Provider Business Practice Location Address
First Line : 211 13TH ST
Second Line :
City : RAMONA
State : CA
Zip : 92065-2711
Country : US
Telephone Number : 760-789-5160
Fax Number : 760-789-6316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2010
Last Update Date : 02/16/2024

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Directions to “ CHARLES LYNN HARDISON MD” Practice Location

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