Provider Demographics
NPI:1891746541
Name:HARDERS, GREGORY P (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
Last Name:HARDERS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:ONE VANTAGEWAY, SUITE B240
Mailing Address - Street 2:MIDDLE TENNESSEE EMERGENCY PHYSICIANS, PC
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1562
Mailing Address - Country:US
Mailing Address - Phone:615-329-4020
Mailing Address - Fax:615-327-5475
Practice Address - Street 1:3100 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5746
Practice Address - Country:US
Practice Address - Phone:907-225-5171
Practice Address - Fax:907-370-2533
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28351146D00000X
TN52680207P00000X
AK214852207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG70389Medicare UPIN
AZZ63492Medicare PIN