Provider Demographics
NPI:1962438929
Name:HARDEN, GLEN (MD)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:
Last Name:HARDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310047
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50331-0047
Mailing Address - Country:US
Mailing Address - Phone:888-398-6437
Mailing Address - Fax:
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1394
Practice Address - Country:US
Practice Address - Phone:712-279-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27021207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
33034OtherWELLMARK BCBS
24224OtherMIDLANDS CHOICE
421344575OtherCHAMPUS
IA2130468Medicaid
SD7701190Medicaid
421344575OtherWELLMARK SELECT
421344575OtherWELLMARK SELECT
33034OtherWELLMARK BCBS
IA2130468Medicaid