Provider Demographics
NPI:1235248584
Name:HARBOUR, DANNY MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:MITCHELL
Last Name:HARBOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 FOREST GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-8831
Mailing Address - Country:US
Mailing Address - Phone:406-538-2912
Mailing Address - Fax:
Practice Address - Street 1:310 WENDELL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2267
Practice Address - Country:US
Practice Address - Phone:406-538-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTF75188Medicare UPIN