Provider Demographics
NPI:1184698292
Name:HARDY, CHRISTOPHER GARETH (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:GARETH
Last Name:HARDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4027 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4972
Practice Address - Country:US
Practice Address - Phone:425-339-5489
Practice Address - Fax:425-317-3689
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP602709192083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOP60270919OtherLICENSE
WA2017199Medicaid
WAG8912874Medicare PIN