Provider Demographics
NPI:1194703496
Name:HARDIN, CHARLES KENNETT (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KENNETT
Last Name:HARDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1312 GENEVA ST STE B
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-2941
Mailing Address - Country:US
Mailing Address - Phone:210-580-4880
Mailing Address - Fax:830-584-0409
Practice Address - Street 1:1312 GENEVA ST STE B
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-2941
Practice Address - Country:US
Practice Address - Phone:210-580-4880
Practice Address - Fax:830-584-0409
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1258208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty