=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407807829
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN WAYNE HARLAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 N ORANGE ST SUITE 106
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59802-2998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-542-7300
-----------------------------------------------------
Fax | 406-542-0003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 N ORANGE ST SUITE 106
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59802-2998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-542-7300
-----------------------------------------------------
Fax | 406-542-0003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 4244
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------