Provider Demographics
NPI:1326469743
Name:HARDY, CURTIS LAMAR (DO)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:LAMAR
Last Name:HARDY
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 1:835 D AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2183
Mailing Address - Country:US
Mailing Address - Phone:803-834-9000
Mailing Address - Fax:
Practice Address - Street 1:2924 SISKIYOU BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6462
Practice Address - Country:US
Practice Address - Phone:541-200-2777
Practice Address - Fax:541-214-2575
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO209078207ND0101X, 207ND0900X, 207N00000X
CA20A19597207ND0101X, 207ND0900X, 207N00000X
VA0102204286207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500804519Medicaid