Provider Demographics
NPI:1518923440
Name:HARDOIN, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:HARDOIN
Suffix:
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 1:53 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-3201
Mailing Address - Country:US
Mailing Address - Phone:979-297-6379
Mailing Address - Fax:979-297-9096
Practice Address - Street 1:54 FLAG LAKE PLZ
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6263
Practice Address - Country:US
Practice Address - Phone:979-297-8793
Practice Address - Fax:979-297-9096
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2276208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82972YOtherBLUE CROSS BLUE SHIELD
TXE77664Medicare UPIN