Provider Demographics
NPI:1790735058
Name:HARDY, STEPHEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:HARDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2802 GREAT NORTHERN LOOP
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1738
Mailing Address - Country:US
Mailing Address - Phone:406-728-3811
Mailing Address - Fax:406-721-9141
Practice Address - Street 1:2802 GREAT NORTHERN LOOP
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1738
Practice Address - Country:US
Practice Address - Phone:406-728-3811
Practice Address - Fax:406-721-9141
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT95932086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTF27065Medicare UPIN