Provider Demographics
NPI:1881658094
Name:HARDIN, JOEL SHANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:SHANE
Last Name:HARDIN
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 1:300 WERNER ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6406
Mailing Address - Country:US
Mailing Address - Phone:501-622-1043
Mailing Address - Fax:501-622-1199
Practice Address - Street 1:300 WERNER ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6406
Practice Address - Country:US
Practice Address - Phone:501-622-1043
Practice Address - Fax:501-622-1199
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3651207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M6216972OtherMEDICARE LINKED
AR5M6216972OtherMEDICARE LINKED
ARH87067Medicare UPIN