Provider Demographics
NPI:1043297435
Name:HARDEE, MARTHA LOVE (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LOVE
Last Name:HARDEE
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 1:8335 WALNUT HILL LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4256
Mailing Address - Country:US
Mailing Address - Phone:214-382-5810
Mailing Address - Fax:214-382-5816
Practice Address - Street 1:8335 WALNUT HILL LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4256
Practice Address - Country:US
Practice Address - Phone:214-382-5810
Practice Address - Fax:214-382-5816
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX891687OtherBLUE CROSS BLUE SHIELD
TX891687OtherBLUE CROSS BLUE SHIELD
TXC16576Medicare UPIN