Individual
DOUGLAS HARDEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1841 MADORA AVE, DOUGLAS, WY 82633
(307) 358-2846
Mailing address
1841 MADORA AVE, DOUGLAS, WY 82633-3057
(307) 358-2846
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106402907
—
WY
05
—
106402908
—
WY
Enumeration date
07/10/2014
Last updated
04/30/2019
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