MEDICARE: DR. CLARENCE DEAN HARKNESS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO170	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000252197	OTHER	HI	HMSA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508917022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARENCE DEAN HARKNESS DPM

Provider Business Mailing Address
First Line	:	RR 3 BOX 1350
Second Line	:
City	:	PAHOA
State	:	HI
Zip	:	96778-7521
Country	:	US
Telephone Number	:	808-961-5700
Fax Number	:	808-961-5799

Provider Business Practice Location Address
First Line	:	73 PUUHONU PL RM 105
Second Line	:
City	:	HILO
State	:	HI
Zip	:	96720-2060
Country	:	US
Telephone Number	:	808-961-5700
Fax Number	:	808-961-5799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	10/04/2012

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