Provider Demographics
NPI:1629182829
Name:HARDY, JEFFERY A (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:A
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 1:2344 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2909
Mailing Address - Country:US
Mailing Address - Phone:314-647-2344
Mailing Address - Fax:314-647-6108
Practice Address - Street 1:2344 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2909
Practice Address - Country:US
Practice Address - Phone:314-647-2344
Practice Address - Fax:314-647-6108
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6F552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202638508Medicaid
MO194361OtherBLUE SHIELD
268169OtherHEALTHLINK
MO1600056OtherUNITED HEALTH CARE
4897V12822OtherHEALTHCARE USA
300015827OtherRAILROAD MEDICARE
MO3848OtherCMR
27716OtherGROUP HEALTH PLAN
A12090OtherMERCY HEALTH PLAN
MO194361OtherBLUE SHIELD
MO1600056OtherUNITED HEALTH CARE