Provider Demographics
NPI:1144547662
Name:HARDY, JOHN SHERMAN JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SHERMAN
Last Name:HARDY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:7153 SEAWITCH LN NW
Mailing Address - Street 2:
Mailing Address - City:SEABECK
Mailing Address - State:WA
Mailing Address - Zip Code:98380-9593
Mailing Address - Country:US
Mailing Address - Phone:360-830-9364
Mailing Address - Fax:360-830-3341
Practice Address - Street 1:7153 SEAWITCH LN NW
Practice Address - Street 2:
Practice Address - City:SEABECK
Practice Address - State:WA
Practice Address - Zip Code:98380-9593
Practice Address - Country:US
Practice Address - Phone:360-830-9364
Practice Address - Fax:360-830-3341
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036114207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS27769Medicare UPIN