Provider Demographics
NPI:1407353907
Name:HARDY, SPENCER (DPM)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:HARDY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 S RICO
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5526
Mailing Address - Country:US
Mailing Address - Phone:480-204-7118
Mailing Address - Fax:
Practice Address - Street 1:6104 E BROWN RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4953
Practice Address - Country:US
Practice Address - Phone:480-219-4100
Practice Address - Fax:877-258-1138
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-000998213ES0103X, 213E00000X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine