Basic Information
Provider Information | |||||||||
NPI: | 1699749424 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HARBRECHT | ||||||||
FirstName: | JEFFREY | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5400 FRANTZ RD | ||||||||
Address2: | STE 250 | ||||||||
City: | DUBLIN | ||||||||
State: | OH | ||||||||
PostalCode: | 430164144 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6145446155 | ||||||||
FaxNumber: | 6145446370 | ||||||||
Practice Location | |||||||||
Address1: | 500 THOMAS LN | ||||||||
Address2: | SUITE 3C | ||||||||
City: | COLUMBUS | ||||||||
State: | OH | ||||||||
PostalCode: | 432143902 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6145382222 | ||||||||
FaxNumber: | 6145382233 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/16/2006 | ||||||||
LastUpdateDate: | 01/05/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 35065043H | OH | Y |   | Allopathic & Osteopathic Physicians | Urology |   |
ID Information
ID | Type | State | Issuer | Description | 0929366 | 05 | OH |   | MEDICAID | 1900228 | 01 | OH | UHC | OTHER | 000000116898 | 01 | OH | ANTHEM | OTHER |