Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 3937 | AL |
NPI | 1043315617 |
---|---|
Provider Name | Dr. Robert Cyrus Haraway JR. |
First Address | Tuscaloosa, AL 35404 |
Second Address | Tuscaloosa, AL 35404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
90664 | BCBS OF AL (01) | AL |
T93646 | (02) |