Provider Demographics
NPI:1225083942
Name:HARDIN, ROBERT HOUSTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HOUSTON
Last Name:HARDIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 HERITAGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2401
Practice Address - Country:US
Practice Address - Phone:601-499-2873
Practice Address - Fax:601-355-7170
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS184902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01522859Medicaid
MSPTAN 302I300905Medicare PIN
MSH27140Medicare UPIN
MS300000917Medicare ID - Type Unspecified