Provider Demographics
NPI:1992819627
Name:HARNESS, HARRY TAYLOR (DO)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:TAYLOR
Last Name:HARNESS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N WESTWOOD BLVD
Mailing Address - Street 2:P.O. BOX 327
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3318
Mailing Address - Country:US
Mailing Address - Phone:573-778-4760
Mailing Address - Fax:
Practice Address - Street 1:315 WEST MULBERRY STREET
Practice Address - Street 2:
Practice Address - City:PILOT KNOB
Practice Address - State:MO
Practice Address - Zip Code:63663
Practice Address - Country:US
Practice Address - Phone:573-546-0602
Practice Address - Fax:573-546-0624
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235207Q00000X
MOR9682207Q00000X
TNDO0000000858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC002357Medicaid
SCF032967981Medicare ID - Type Unspecified
SC002357Medicaid