Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2013017875 | MO |
Y | 207QS0010X | Family Doctor - Sports Medicine | 2015032303 | MO |
NPI | 1134568918 |
---|---|
Provider Name | Adam Lee Harrold |
First Address | Kansas City, MO 64121-9672 |
Second Address | Liberty, MO 64068-3313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2013 |
Last Update Date | 09/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
56906012 | BCBS (01) | MO |