Provider Demographics
NPI:1043226392
Name:HARDY, JULIE C (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:HARDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3609
Mailing Address - Country:US
Mailing Address - Phone:512-459-4147
Mailing Address - Fax:512-459-9134
Practice Address - Street 1:1101 W 40TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3609
Practice Address - Country:US
Practice Address - Phone:512-459-4147
Practice Address - Fax:512-459-9134
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL1603OtherMEDICAL LICENSE
TX00J40TOtherMEDICARE ID
TX00J40TOtherMEDICARE ID
TXH30658Medicare UPIN
TX8586K6Medicare PIN
TX8586K6Medicare PIN