Provider Demographics
NPI:1780616243
Name:HARDING, R MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:R
Middle Name:MICHAEL
Last Name:HARDING
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 1:209 CEDAR TREE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-9370
Mailing Address - Country:US
Mailing Address - Phone:541-430-3958
Mailing Address - Fax:
Practice Address - Street 1:209 CEDAR TREE DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-9370
Practice Address - Country:US
Practice Address - Phone:541-430-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMD54406207P00000X
WAMD60807213207P00000X
MEMD21834207P00000X
IAMD44724207P00000X
ORMD13593207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORE59247Medicare UPIN