Provider Demographics
NPI:1962471037
Name:HARDEN, JEFFREY C (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:HARDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CROWN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2510
Mailing Address - Country:US
Mailing Address - Phone:660-665-7500
Mailing Address - Fax:660-665-7546
Practice Address - Street 1:1 CROWN DR
Practice Address - Street 2:SUITE 104
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2510
Practice Address - Country:US
Practice Address - Phone:660-665-7500
Practice Address - Fax:660-665-7546
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6D632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000005781OtherGATEWAY EDI
MO431554537-63501OtherCHAMPUS
MO242657500Medicaid
MOBLUE CROSS/BLUE SHIEOther13044
MOE59579Medicare UPIN
MO000005781OtherGATEWAY EDI