Provider Demographics
NPI:1679501704
Name:HARKNESS, STEPHEN OWEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:OWEN
Last Name:HARKNESS
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 1:101 FAIRWAY DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7503
Mailing Address - Country:US
Mailing Address - Phone:985-892-8959
Mailing Address - Fax:985-892-8975
Practice Address - Street 1:101 FAIRWAY DR
Practice Address - Street 2:SUITE 402
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7503
Practice Address - Country:US
Practice Address - Phone:985-892-8959
Practice Address - Fax:985-892-8975
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96909208600000X, 2086S0129X, 208C00000X, 208D00000X
LAMD.013676208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1319171Medicaid
FLP00381699OtherRAILROAD MEDICARE
FLB64254OtherBCBS FL
FL277130600Medicaid
FLB64254OtherBCBS FL
FLB64254Medicare UPIN
FL277130600Medicaid