Healthcare Provider Details

I. General information

NPI: 1285700088
Provider Name (Legal Business Name): JARROD MICHAEL HARRALL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 RESEARCH PARKWAY SUITE 200
COLORADO SPRINGS CO
80920
US

IV. Provider business mailing address

1651 NAISMITH DR
LAWRENCE KS
66045-4069
US

V. Phone/Fax

Practice location:
  • Phone: 719-623-1050
  • Fax: 719-623-1051
Mailing address:
  • Phone: 785-864-2306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number390200000X
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDR.0050921
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0534983
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number05-34983
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: