Provider Demographics
NPI:1194713248
Name:HARDWICKE, FRED E (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:E
Last Name:HARDWICKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BELLA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-2304
Mailing Address - Country:US
Mailing Address - Phone:806-778-2688
Mailing Address - Fax:940-937-9615
Practice Address - Street 1:1001 US HIGHWAY 83 N
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-2322
Practice Address - Country:US
Practice Address - Phone:940-937-3636
Practice Address - Fax:940-937-9615
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0428207RX0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135619803Medicaid
NM63916Medicaid
TX114565101Medicaid
TX135619804Medicaid
OK100166970AMedicaid
NM63916OtherPRESBYTERIAN COMMERCIAL
NM77643Medicaid
TX81321YOtherBC/BS
A416OtherTRIWEST
TX84210ZOtherHMO BLUE
TX114565100OtherFIRSTCARE COMMERCIAL
TX114565101Medicaid
TX830006517Medicare ID - Type UnspecifiedRAILROAD
NM63916Medicaid