Provider Demographics
NPI:1912201898
Name:HARDMAN, MICK JOSEPH (PA-C)
Entity Type:Individual
Prefix:
First Name:MICK
Middle Name:JOSEPH
Last Name:HARDMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 S. MEDICAL CENTER DRIVE #120
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:435-628-4460
Mailing Address - Fax:435-628-4469
Practice Address - Street 1:652 S MEDICAL CENTER DR
Practice Address - Street 2:#120
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7017
Practice Address - Country:US
Practice Address - Phone:435-628-4460
Practice Address - Fax:435-628-4469
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7858059-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant