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NPI Code Detail

MEDICARE: DR. GARY JOSEPH HARDOON M.D.

MEDICARE: DR. GARY JOSEPH HARDOON 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
1207R00000XInternal Medicine PhysicianME122790FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PU936OTHERFLMEDICARE HF

General Provider Information

NPI Number : 1558637686
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY JOSEPH HARDOON M.D.
Provider Business Mailing Address
First Line : 3300 S FISKE BLVD
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32955-4306
Country : US
Telephone Number : 321-312-3466
Fax Number : 321-409-6811
Provider Business Practice Location Address
First Line : 1810 ELDRON BLVD SE
Second Line :
City : PALM BAY
State : FL
Zip : 32909-6831
Country : US
Telephone Number : 321-312-3466
Fax Number : 321-409-6811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2012
Last Update Date : 10/28/2022

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