Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 010099 | MO |
NPI | 1023178571 |
---|---|
Provider Name | Dr. Jerry D Harl |
First Address | Columbia, MO 65203 |
Second Address | Osage Beach, MO 65065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |