Healthcare Provider Details

I. General information

NPI: 1558369306
Provider Name (Legal Business Name): JOHN M. HARCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

303 MAPLE ST
MOUNT SHASTA CA
96067-2229
US

IV. Provider business mailing address

303 MAPLE ST
MOUNT SHASTA CA
96067-2229
US

V. Phone/Fax

Practice location:
  • Phone: 530-926-0892
  • Fax: 530-926-0895
Mailing address:
  • Phone: 530-926-0892
  • Fax: 530-926-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG51314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: