Healthcare Provider Details

I. General information

NPI: 1134478860
Provider Name (Legal Business Name): LOGAN HARDING MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 PICCADILLY DR
SIERRA VISTA AZ
85635-5090
US

IV. Provider business mailing address

1765 PICCADILLY DR
SIERRA VISTA AZ
85635-5090
US

V. Phone/Fax

Practice location:
  • Phone: 520-515-9751
  • Fax: 520-515-9786
Mailing address:
  • Phone: 520-515-9751
  • Fax: 520-515-9786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number43638
License Number StateAZ

VIII. Authorized Official

Name: LOGAN Z HARDING
Title or Position: PRESIDENT
Credential: MD
Phone: 520-515-9751