Provider Demographics
NPI:1942522388
Name:HARDY, JOHN HENRY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:HARDY
Suffix:JR
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 1:700 N HAYDEN ISLAND DR STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-8183
Mailing Address - Country:US
Mailing Address - Phone:971-533-5840
Mailing Address - Fax:971-270-2806
Practice Address - Street 1:700 N HAYDEN ISLAND DR STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-8183
Practice Address - Country:US
Practice Address - Phone:971-533-5840
Practice Address - Fax:971-270-2806
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD188622083A0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD18862OtherOREGON MEDICAL BOARD