Provider Demographics
NPI:1639174907
Name:HARDIN, DAVID MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:HARDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5220 BELFORT RD
Mailing Address - Street 2:STE 130
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6017
Mailing Address - Country:US
Mailing Address - Phone:904-446-3451
Mailing Address - Fax:904-446-3013
Practice Address - Street 1:9399 CROWN CREST BLVD
Practice Address - Street 2:SUITE 430
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8506
Practice Address - Country:US
Practice Address - Phone:303-269-2310
Practice Address - Fax:904-446-3013
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2015-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA82975208600000X
ORMD29305208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH88414Medicare UPIN
CAH88414Medicare UPIN