Provider Demographics
NPI:1558369306
Name:HARCH, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:HARCH
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 1:303 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2229
Mailing Address - Country:US
Mailing Address - Phone:530-926-0892
Mailing Address - Fax:530-926-0895
Practice Address - Street 1:303 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2229
Practice Address - Country:US
Practice Address - Phone:530-926-0892
Practice Address - Fax:530-926-0895
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2009-07-02
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
CAG51314208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G513140Medicaid
CAA51970Medicare UPIN
CA00G513140Medicaid
CABV851AMedicare PIN