Provider Demographics
NPI:1518928407
Name:HARDY, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HARDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUILDING 3334
Mailing Address - Street 2:
Mailing Address - City:TINKER AIR FORCE BASE
Mailing Address - State:OK
Mailing Address - Zip Code:73118
Mailing Address - Country:US
Mailing Address - Phone:405-734-2778
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 3334
Practice Address - Street 2:
Practice Address - City:TINKER AIR FORCE BASE
Practice Address - State:OK
Practice Address - Zip Code:73118
Practice Address - Country:US
Practice Address - Phone:405-734-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3082083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine