Provider Demographics
NPI:1356653000
Name:FLAGSTAFF CENTER FOR BONE AND JOINT DISORDERS
Entity Type:Organization
Organization Name:FLAGSTAFF CENTER FOR BONE AND JOINT DISORDERS
Other - Org Name:FLAGSTAFF BONE AND JOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR ORTHOPAEDIC SURGERY
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-214-2890
Mailing Address - Street 1:77 W FOREST AVE
Mailing Address - Street 2:301
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1479
Mailing Address - Country:US
Mailing Address - Phone:928-214-2836
Mailing Address - Fax:928-214-2837
Practice Address - Street 1:525 N SWITZER CANYON DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4845
Practice Address - Country:US
Practice Address - Phone:928-214-2836
Practice Address - Fax:928-214-2837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55392251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5539OtherSTATE LICENSE