Healthcare Provider Details

I. General information

NPI: 1376530519
Provider Name (Legal Business Name): DOUGLAS WAYNE HARLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 SOUTH BROADWAY STREET CANAL PHYSICIANS GROUP
AKRON OH
44311-1059
US

IV. Provider business mailing address

676 SOUTH BROADWAY STREET CANAL PHYSICIANS GROUP
AKRON OH
44311-1059
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-4000
  • Fax: 330-253-2349
Mailing address:
  • Phone: 330-344-4000
  • Fax: 330-253-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34008403
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: