Basic Information
| Provider Information | |||||||||
| NPI: | 1114976339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDMON | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2519 N MCMULLEN BOOTH RD | ||||||||
| Address2: | SUITE 510 PMB-263 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337614173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274928561 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9325 BAY PLAZA BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336194462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134900099 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2006 | ||||||||
| LastUpdateDate: | 11/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS06023 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.