Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | IL | |
Y | 208600000X | Surgeon | IL |
NPI | 1003877606 |
---|---|
Provider Name | Dr. William R Hardy |
First Address | Mt Carmel, IL 62863-2649 |
Second Address | Mount Carmel, IL 62863-2649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E02611 | (02) | IL |