Provider Demographics
NPI:1730123357
Name:HARDIN, WILLIAM EUGENE (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EUGENE
Last Name:HARDIN
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 1:4623 DELWOOD VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7108
Mailing Address - Country:US
Mailing Address - Phone:850-230-4349
Mailing Address - Fax:
Practice Address - Street 1:NAVAL SUPPORT ACTIVITY
Practice Address - Street 2:101 VERNON AVE.,BLDG 387
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-7018
Practice Address - Country:US
Practice Address - Phone:850-636-7000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 13965207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB59524Medicare UPIN