Basic Information
| Provider Information | |||||||||
| NPI: | 1750493797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDENBERGH | ||||||||
| FirstName: | GORDON | ||||||||
| MiddleName: | SLAUGHTER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 MAIN ST # C301 | ||||||||
| Address2: | |||||||||
| City: | EDWARDS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816328109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705693600 | ||||||||
| FaxNumber: | 9705693601 | ||||||||
| Practice Location | |||||||||
| Address1: | 181 W MEADOW DR | ||||||||
| Address2: | |||||||||
| City: | VAIL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816575242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704797225 | ||||||||
| FaxNumber: | 9704797216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207P00000X | 33058 | CO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 73229733 | 05 | CO | MEDICAID |