Provider Demographics
NPI:1629074950
Name:HARMON, TAZ JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:TAZ
Middle Name:JOSEPH
Last Name:HARMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 N KEENE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8131
Mailing Address - Country:US
Mailing Address - Phone:573-499-4990
Mailing Address - Fax:573-442-2120
Practice Address - Street 1:105 N KEENE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8131
Practice Address - Country:US
Practice Address - Phone:573-499-4990
Practice Address - Fax:573-442-2120
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2010009943208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ456089Medicaid
AZ456089Medicaid
AZG87476Medicare UPIN