Provider Demographics
NPI:1427086941
Name:HARLAN, JOHN WOODY (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WOODY
Last Name:HARLAN
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 1:2000 SE BLUE PKWY
Mailing Address - Street 2:SUITE 270-A
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1041
Mailing Address - Country:US
Mailing Address - Phone:816-524-1700
Mailing Address - Fax:816-524-1794
Practice Address - Street 1:2000 SE BLUE PKWY
Practice Address - Street 2:SUITE 270-A
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1041
Practice Address - Country:US
Practice Address - Phone:816-524-1700
Practice Address - Fax:816-524-1794
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7F642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202309100Medicaid
MO1427086941Medicaid
KS100139930 DMedicaid
MO1427086941Medicaid
MOX115854Medicare PIN
MO0705854AMedicare ID - Type Unspecified
KS100139930 DMedicaid
MO202309100Medicaid