MEDICARE: JOE B HARBISON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	8864	OK
2	2085R0202X	Diagnostic Radiology Physician	ME19880	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	03086	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1235283805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE B HARBISON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1770
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32402-1770
Country	:	US
Telephone Number	:	850-747-4905
Fax Number	:	850-747-4907

Provider Business Practice Location Address
First Line	:	527 N PALO ALTO AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3639
Country	:	US
Telephone Number	:	850-747-4905
Fax Number	:	850-747-4907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	11/13/2008

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Directions to “ JOE B HARBISON M.D.” Practice Location

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