Provider Demographics
NPI:1750493797
Name:HARDENBERGH, GORDON SLAUGHTER (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:SLAUGHTER
Last Name:HARDENBERGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:27 MAIN ST # C301
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-8109
Mailing Address - Country:US
Mailing Address - Phone:970-569-3600
Mailing Address - Fax:970-569-3601
Practice Address - Street 1:181 W MEADOW DR
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-5242
Practice Address - Country:US
Practice Address - Phone:970-479-7225
Practice Address - Fax:970-479-7216
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33058207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73229733Medicaid
CO441908Medicare ID - Type UnspecifiedVAIL VALLEY MEDICAL CTR
G12461Medicare UPIN