Healthcare Provider Details

I. General information

NPI: 1356559975
Provider Name (Legal Business Name): MARK DOUGLAS HARWOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W. 7TH AVENUE STE. 450
SPOKANE WA
99204-2352
US

IV. Provider business mailing address

PO BOX 331
LIBERTY LAKE WA
99019-0331
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-8820
  • Fax: 509-838-4978
Mailing address:
  • Phone: 866-747-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6053858-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60284972
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD60284972
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: