Basic Information
| Provider Information | |||||||||
| NPI: | 1407171952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDING | ||||||||
| FirstName: | LOGAN | ||||||||
| MiddleName: | Z | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 CALLE PORTAL | ||||||||
| Address2: | SUITE B260A | ||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856352967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205159751 | ||||||||
| FaxNumber: | 5205159786 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 CALLE PORTAL | ||||||||
| Address2: | SUITE B-260A | ||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856352967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205159751 | ||||||||
| FaxNumber: | 5205159786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2010 | ||||||||
| LastUpdateDate: | 09/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 43638 | AZ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.