Healthcare Provider Details

I. General information

NPI: 1407171952
Provider Name (Legal Business Name): LOGAN Z HARDING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2010
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 16TH ST
PUEBLO CO
81003-2745
US

IV. Provider business mailing address

77 CALLE PORTAL SUITE B260A
SIERRA VISTA AZ
85635-2967
US

V. Phone/Fax

Practice location:
  • Phone: 719-584-4045
  • Fax:
Mailing address:
  • Phone: 520-515-9751
  • Fax: 520-515-9786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number43638
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0075351
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: