Provider Demographics
NPI:1598593238
Name:HARDRICK, BRENT CHAD
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:CHAD
Last Name:HARDRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11604 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-5602
Mailing Address - Country:US
Mailing Address - Phone:918-630-6029
Mailing Address - Fax:
Practice Address - Street 1:11604 E 23RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5602
Practice Address - Country:US
Practice Address - Phone:918-630-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist