Provider Demographics
NPI:1366406373
Name:HARDIN, STEPHEN CLAY (PAC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CLAY
Last Name:HARDIN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 S LOOP 256
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801
Mailing Address - Country:US
Mailing Address - Phone:903-731-9599
Mailing Address - Fax:903-731-4202
Practice Address - Street 1:1920 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801
Practice Address - Country:US
Practice Address - Phone:903-731-9599
Practice Address - Fax:903-731-4202
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03184363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q04264Medicare UPIN
TX8C7161Medicare PIN