Provider Demographics
NPI:1114976339
Name:HARDMON, KEVIN B (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:B
Last Name:HARDMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 510 PMB-263
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4173
Mailing Address - Country:US
Mailing Address - Phone:727-492-8561
Mailing Address - Fax:
Practice Address - Street 1:9325 BAY PLAZA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4462
Practice Address - Country:US
Practice Address - Phone:813-490-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2009-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS06023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE86207Medicare UPIN
FL82865HMedicare ID - Type Unspecified
FL82865UMedicare ID - Type Unspecified