Provider Demographics
NPI:1356312433
Name:HARDIN, RONALD D SR (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:HARDIN
Suffix:SR
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 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7215
Mailing Address - Fax:501-812-7207
Practice Address - Street 1:9501 BAPTIST HEALTH DR STE 165
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6226
Practice Address - Country:US
Practice Address - Phone:501-219-0721
Practice Address - Fax:501-224-1198
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4626207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C4826OtherTRICARE
AR104758001Medicaid
AR13669000010OtherQUALCHOICE
AR52123OtherBLUE CROSS BLUE
AR5H9866884Medicare PIN
C4826OtherTRICARE
AR104758001Medicaid