Provider Demographics
NPI:1922488857
Name:HARDIN, JACOB (RT(R)(MR))
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:HARDIN
Suffix:
Gender:M
Credentials:RT(R)(MR)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 KIPLING WAY APT 202
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7251
Mailing Address - Country:US
Mailing Address - Phone:573-864-9381
Mailing Address - Fax:
Practice Address - Street 1:5 KIPLING WAY APT 202
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7251
Practice Address - Country:US
Practice Address - Phone:573-864-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5048022471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging