Healthcare Provider Details

I. General information

NPI: 1134568918
Provider Name (Legal Business Name): ADAM LEE HARROLD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 GLENN HENDREN DR
LIBERTY MO
64068-3313
US

IV. Provider business mailing address

PO BOX 219672
KANSAS CITY MO
64121-9672
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-7730
  • Fax: 816-781-6973
Mailing address:
  • Phone: 816-407-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2013017875
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2015032303
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: