Healthcare Provider Details

I. General information

NPI: 1114913431
Provider Name (Legal Business Name): ROBERT JACK HARDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 CAPITOL ST NE
SALEM OR
97301-0644
US

IV. Provider business mailing address

PO BOX 8100
SALEM OR
97303-0900
US

V. Phone/Fax

Practice location:
  • Phone: 503-399-2470
  • Fax: 503-375-7429
Mailing address:
  • Phone: 503-399-2470
  • Fax: 503-375-7429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD153206
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: