MEDICARE: JONATHAN NORMAN HARDY DO

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	207P00000X	Emergency Medicine Physician	S5916	TX

General Provider Information

NPI Number	:	1639673056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN NORMAN HARDY DO

Provider Business Mailing Address
First Line	:	1500 S MAIN ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-4941
Country	:	US
Telephone Number	:	817-702-1173
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S MAIN ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-4941
Country	:	US
Telephone Number	:	817-702-1173
Fax Number	:

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

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	04/27/2020

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