Individual
DR. GLENN HARDESTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
800 W RANDOL MILL RD, ARLINGTON, TX 76012-2504
(817) 548-6202
Mailing address
P O BOX 960160, OKLAHOMA CITY, OK 73196-0001
(877) 485-4474
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
K8201
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029651902
—
TX
05
—
029651903
—
TX
01
—
88778Z
BCBS THRU AEMA
TX
01
—
8BT321
BCBS THRU SAEMA
TX
01
—
930124542
RAILROAD THRU AEMA
TX
01
—
P01207143
RAILROAD MCARE
TX
Enumeration date
03/16/2006
Last updated
10/15/2013
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