Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301079990 | MI |
N | 111NI0900X | Internist | 4301079990 | MI |
N | 207R00000X | Internist | N5707 | TX |
N | 111NI0900X | Internist | N5707 | TX |
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 49675 | AZ |
Y | 207RC0000X | Internist - Cardiovascular Disease | 49675 | AZ |
N | 207RC0000X | Internist - Cardiovascular Disease | N5707 | TX |
NPI | 1720032402 |
---|---|
Provider Name | Dr. Brian William Hardaway |
First Address | Scottsdale, AZ 85259-5452 |
Second Address | Scottsdale, AZ 85259-5452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 03/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140182 | (02) | TX |