Healthcare Provider Details

I. General information

NPI: 1609869536
Provider Name (Legal Business Name): BRENT M HARWOOD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23937 HWY 98
MONTROSE AL
36559
US

IV. Provider business mailing address

23937 US HIGHWAY 98 STE 1
FAIRHOPE AL
36532-3359
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-6768
  • Fax: 251-928-0783
Mailing address:
  • Phone: 251-928-6768
  • Fax: 251-928-0783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number155
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: