Healthcare Provider Details

I. General information

NPI: 1033221353
Provider Name (Legal Business Name): CHARLES S. HARRIMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 CITY BUSINESS ROUTE 66
SAINT ROBERT MO
65584-0974
US

IV. Provider business mailing address

608 CITY ROUTE 66
SAINT ROBERT MO
65584-0974
US

V. Phone/Fax

Practice location:
  • Phone: 553-336-5100
  • Fax: 573-336-3118
Mailing address:
  • Phone: 573-336-5100
  • Fax: 573-336-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number101451
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: