Healthcare Provider Details

I. General information

NPI: 1295802403
Provider Name (Legal Business Name): HARCHARAN BAINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S SPRINGFIELD AVE
BOLIVAR MO
65613-2512
US

IV. Provider business mailing address

1500 N OAKLAND AVE
BOLIVAR MO
65613-3011
US

V. Phone/Fax

Practice location:
  • Phone: 417-326-7814
  • Fax: 417-326-4059
Mailing address:
  • Phone: 417-328-6501
  • Fax: 417-328-6338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2006034005
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: