Provider Demographics
NPI:1235283805
Name:HARBISON, JOE B (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:B
Last Name:HARBISON
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:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-1770
Mailing Address - Country:US
Mailing Address - Phone:850-747-4905
Mailing Address - Fax:850-747-4907
Practice Address - Street 1:527 N PALO ALTO AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3639
Practice Address - Country:US
Practice Address - Phone:850-747-4905
Practice Address - Fax:850-747-4907
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88642085R0202X
FLME198802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037962000Medicaid
FL03086OtherBCBS
FL037962000Medicaid
FL03086Medicare ID - Type Unspecified