Provider Demographics
NPI:1558349860
Name:HARDY, WARREN DALE (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:DALE
Last Name:HARDY
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 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE A107
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6774
Mailing Address - Country:US
Mailing Address - Phone:251-433-4700
Mailing Address - Fax:251-435-8549
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE A107
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6774
Practice Address - Country:US
Practice Address - Phone:251-435-8572
Practice Address - Fax:251-435-8615
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16613174400000X, 207RI0011X
MS14085174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126607Medicaid
AL1063477644OtherGROUP NPI
AL009902515Medicaid
AL1558349860OtherINDIVIDUAL NPI
ALG364OtherGROUP MEDICARE NUMBER
AL07817Medicare PIN
ALG364OtherGROUP MEDICARE NUMBER
AL009902515Medicaid
MS060000661Medicare PIN