Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 22765 | KY |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 22756 | KY |
NPI | 1447247978 |
---|---|
Provider Name | Charles Edward Hardin JR. |
First Address | Salyersville, KY 41465-0088 |
Second Address | Salyersville, KY 41465-9248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 31/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64227564 | (05) | KY |
C74889 | (02) | KY |