Provider Demographics
NPI:1831139971
Name:HARDY, CARL E (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:HARDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARL
Other - Middle Name:
Other - Last Name:HARDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:128 GOLDEN GATE PT
Mailing Address - Street 2:702
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-6627
Mailing Address - Country:US
Mailing Address - Phone:941-228-3328
Mailing Address - Fax:
Practice Address - Street 1:128 GOLDEN GATE PT
Practice Address - Street 2:702
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-6627
Practice Address - Country:US
Practice Address - Phone:941-228-3328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51219207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00179417OtherRAILROAD MEDICARE
FL05998OtherBLUE CROSS BLUE SHIELD
FL061151400Medicaid
FL05998OtherBLUE CROSS BLUE SHIELD
FLD51465Medicare UPIN