Healthcare Provider Details

I. General information

NPI: 1427239318
Provider Name (Legal Business Name): LAURA LEIGH HARBISON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E 7TH
CAMERON MO
64429
US

IV. Provider business mailing address

1600 E EVERGREEN
CAMERON MO
64429-0557
US

V. Phone/Fax

Practice location:
  • Phone: 816-632-2111
  • Fax: 816-632-7929
Mailing address:
  • Phone: 816-632-2101
  • Fax: 816-649-3383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008017892
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: