Provider Demographics
NPI:1427022938
Name:RASSNER, LESLIE HARDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:HARDIN
Last Name:RASSNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANNE
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1493 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-5116
Mailing Address - Country:US
Mailing Address - Phone:435-645-6020
Mailing Address - Fax:
Practice Address - Street 1:1493 LOWELL AVE
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-5116
Practice Address - Country:US
Practice Address - Phone:435-645-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4865324-1205207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000073314Medicare PIN