Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | C38943 | CA |
N | 111NI0900X | Internist | C38943 | CA |
N | 207RC0200X | Critical Care Medicine | C38943 | CA |
Y | 207RP1001X | Pulmonary Disease | C38943 | CA |
NPI | 1043399017 |
---|---|
Provider Name | James L Hardeman |
First Address | Fullerton, CA 92835-2523 |
Second Address | Fullerton, CA 92835-2523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 18/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110147479 | RAILROAD MEDICARE (01) | CA |
A37020 | (02) | CA |
C38943 | STATE LICENSE (01) | CA |
GR0014371 | MEDI-CAL I.D (01) | CA |
ZZZ97067Z | BLUE SHIELD (01) | CA |