Provider Demographics
NPI:1285759852
Name:HARBOR INTERNAL MEDICINE PLLC
Entity type:Organization
Organization Name:HARBOR INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-533-6038
Mailing Address - Street 1:1020 ANDERSON DR
Mailing Address - Street 2:STE 205
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1055
Mailing Address - Country:US
Mailing Address - Phone:360-533-6038
Mailing Address - Fax:360-538-0807
Practice Address - Street 1:1020 ANDERSON DR STE 205
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1055
Practice Address - Country:US
Practice Address - Phone:360-533-6038
Practice Address - Fax:360-538-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB33458Medicare PIN