Basic Information
| Provider Information | |||||||||
| NPI: | 1043391352 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARWOOD | ||||||||
| FirstName: | MAURY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 STANDIFORD AVE | ||||||||
| Address2: | SUITE F | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953501159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095795628 | ||||||||
| FaxNumber: | 2095795637 | ||||||||
| Practice Location | |||||||||
| Address1: | 18181 BUTTERFIELD BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | MORGAN HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950378108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087782663 | ||||||||
| FaxNumber: | 4087789197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 01/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | A79199 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00323030 | 01 | CA | RAIL ROAD MEDICARE | OTHER | 00A791990 | 01 | CA | BLUE SHIELD | OTHER | 608896700 | 01 | CA | DEPT OF LABOR | OTHER | 00A791990 | 05 | CA | MEDICAID |