Provider Demographics
NPI:1588623615
Name:HARDY, ROBERT DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:HARDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DOUG
Other - Middle Name:
Other - Last Name:HARDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3900 JUNIUS ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1602
Mailing Address - Country:US
Mailing Address - Phone:214-521-5191
Mailing Address - Fax:214-528-5879
Practice Address - Street 1:4922 SPRING AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75210-1359
Practice Address - Country:US
Practice Address - Phone:214-421-4191
Practice Address - Fax:214-421-1119
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ64772080P0208X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144260001Medicaid
TX8021M7Medicare ID - Type Unspecified
TX144260001Medicaid