Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 014864 | MO |
N | 213EG0000X | General Practice | 014864 | MO |
Y | 1223P0700X | Prosthodontist | 014864 | MO |
NPI | 1053490565 |
---|---|
Provider Name | Dr. Douglas Eugene Harshberger |
First Address | Independence, MO 64055 |
Second Address | Independence, MO 64055-5446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 25/01/2013 |