Provider Demographics
NPI:1073909594
Name:SPENCER J HARDENBROOK MD PC
Entity Type:Organization
Organization Name:SPENCER J HARDENBROOK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-888-1140
Mailing Address - Street 1:12176 S 1000 E
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9734
Mailing Address - Country:US
Mailing Address - Phone:801-572-3750
Mailing Address - Fax:801-572-1097
Practice Address - Street 1:12176 S 1000 E
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9734
Practice Address - Country:US
Practice Address - Phone:800-640-3451
Practice Address - Fax:801-572-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT88335211205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
08121980OtherOWNERS DOB