Provider Demographics
NPI:1912274432
Name:HARDY, CAMERON PHILLIP (PAC)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:PHILLIP
Last Name:HARDY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 W HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2416
Mailing Address - Country:US
Mailing Address - Phone:435-789-6677
Mailing Address - Fax:435-789-6678
Practice Address - Street 1:872 W HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2416
Practice Address - Country:US
Practice Address - Phone:435-781-8899
Practice Address - Fax:435-781-8898
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8152442-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant