Provider Demographics
NPI:1053381558
Name:HARDIN, DANA BROWNING (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:BROWNING
Last Name:HARDIN
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 1:619 SOUTH BLUFF STREET
Mailing Address - Street 2:TOWER 1 SUITE 100
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3853
Mailing Address - Country:US
Mailing Address - Phone:435-656-0234
Mailing Address - Fax:435-656-2622
Practice Address - Street 1:619 SOUTH BLUFF STREET
Practice Address - Street 2:TOWER 1 SUITE 100
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3853
Practice Address - Country:US
Practice Address - Phone:435-656-0234
Practice Address - Fax:435-656-2622
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT993746751205207Q00000X
UT3746751205261QM1300X
UT3746758905261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD2887Medicaid
UTD2887Medicaid
UT005561601Medicare PIN