Provider Demographics
NPI:1366460057
Name:HARDY, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:HARDY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8242
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-8200
Mailing Address - Fax:314-747-4871
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 11C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-8200
Practice Address - Fax:314-747-4871
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO29929208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200406320Medicaid
MO917630219Medicare PIN
MOP00138874Medicare PIN
IL$$$$$$$$$Medicaid