Healthcare Provider Details

I. General information

NPI: 1366632465
Provider Name (Legal Business Name): HARLAN DEAN WADLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 ARDENDALE LN
EUGENE OR
97405-1962
US

IV. Provider business mailing address

1627 ARDENDALE LN
EUGENE OR
97405-1962
US

V. Phone/Fax

Practice location:
  • Phone: 541-852-3168
  • Fax:
Mailing address:
  • Phone: 541-852-3168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD17976
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: