MEDICARE: JOHN TUCKER HARDY 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
1	2084F0202X	Forensic Psychiatry Physician	30618	CO
2	2084P0800X	Psychiatry Physician	30618	CO
3	2084P0804X	Child & Adolescent Psychiatry Physician	30618	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619032182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN TUCKER HARDY MD

Provider Business Mailing Address
First Line	:	1115 N GRAND AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2867
Country	:	US
Telephone Number	:	719-583-4232
Fax Number	:	719-562-4415

Provider Business Practice Location Address
First Line	:	1115 N GRAND AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2867
Country	:	US
Telephone Number	:	719-583-4232
Fax Number	:	719-562-4415

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	01/11/2008

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