Provider Demographics
NPI:1144332560
Name:HARDY, JAMES C JR
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:HARDY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:CHARLES
Other - Last Name:HARDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 662110
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-2110
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:301 E 13TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-6211
Practice Address - Country:US
Practice Address - Phone:209-385-7111
Practice Address - Fax:209-385-7066
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86353207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A863530Medicaid
CA00A863536Medicare PIN
00A863530Medicare PIN