Provider Demographics
NPI:1285609883
Name:HARDEE, MONICA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:JANE
Last Name:HARDEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MONICA
Other - Middle Name:J
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1136 E GRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3982
Mailing Address - Country:US
Mailing Address - Phone:903-592-5601
Mailing Address - Fax:903-595-3304
Practice Address - Street 1:1136 E GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3982
Practice Address - Country:US
Practice Address - Phone:903-592-5601
Practice Address - Fax:903-595-3304
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6628207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159491304Medicaid
TXP00061077Medicare PIN
TX159491304Medicaid
TX8A9187Medicare Oscar/Certification
TX8A9187Medicare Oscar/Certification