Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 10623A | WY |
NPI | 1013273200 |
---|---|
Provider Name | Dr. Brian Charles Hardy |
First Address | Cheyenne, WY 82001-4468 |
Second Address | Cheyenne, WY 82001-3748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2012 |
Last Update Date | 19/08/2016 |