Healthcare Provider Details

I. General information

NPI: 1891746541
Provider Name (Legal Business Name): GREGORY P. HARDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TONGASS AVE
KETCHIKAN AK
99901-5746
US

IV. Provider business mailing address

ONE VANTAGEWAY, SUITE B240 MIDDLE TENNESSEE EMERGENCY PHYSICIANS, PC
NASHVILLE TN
37228-1562
US

V. Phone/Fax

Practice location:
  • Phone: 907-225-5171
  • Fax: 907-370-2533
Mailing address:
  • Phone: 615-329-4020
  • Fax: 615-327-5475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number52680
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number75805
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number28351
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number214852
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: