Provider Demographics
NPI:1508917022
Name:HARKNESS, CLARENCE DEAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:DEAN
Last Name:HARKNESS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 1350
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-7521
Mailing Address - Country:US
Mailing Address - Phone:808-961-5700
Mailing Address - Fax:808-961-5799
Practice Address - Street 1:73 PUUHONU PL RM 105
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2060
Practice Address - Country:US
Practice Address - Phone:808-961-5700
Practice Address - Fax:808-961-5799
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO170213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000252197OtherHMSA
HI56938701Medicaid
HI100377Medicare ID - Type Unspecified
HI56938701Medicaid