Provider Demographics
NPI:1952345902
Name:HARDEY, DAVID W SR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:HARDEY
Suffix:SR
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 1:2963 BORDELON
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611
Mailing Address - Country:US
Mailing Address - Phone:337-802-4159
Mailing Address - Fax:337-855-1743
Practice Address - Street 1:2963 BORDELON
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611
Practice Address - Country:US
Practice Address - Phone:337-802-4159
Practice Address - Fax:337-855-1743
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08095R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5L973CP33Medicare ID - Type Unspecified
LA1393673Medicare ID - Type Unspecified
LAC72327Medicare UPIN