Provider Demographics
NPI:1962606459
Name:TARDY, JOSHUA (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:TARDY
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 1:7959 BROADWAY ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2667
Mailing Address - Country:US
Mailing Address - Phone:210-826-1891
Mailing Address - Fax:210-755-4459
Practice Address - Street 1:7959 BROADWAY ST
Practice Address - Street 2:SUITE 604
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2667
Practice Address - Country:US
Practice Address - Phone:210-826-1891
Practice Address - Fax:210-755-4459
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6706208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics