Healthcare Provider Details

I. General information

NPI: 1184734782
Provider Name (Legal Business Name): VERN HARPOLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E 7TH ST
THE DALLES OR
97058-2676
US

IV. Provider business mailing address

419 E 7TH ST
THE DALLES OR
97058-2676
US

V. Phone/Fax

Practice location:
  • Phone: 541-506-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD09597
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00031720
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: