Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | C-8326 | AR |
NPI | 1003946401 |
---|---|
Provider Name | Bryan M Harvey |
First Address | Rogers, AR 72758-8637 |
Second Address | Rogers, AR 72758-8637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 13/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122915001 | (05) | AR |
F79857 | (02) | AR |