Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 387 | NE |
NPI | 1033195532 |
---|---|
Provider Name | Dr. Scott Harley |
First Address | Camp Pendleton, CA 92055-5191 |
Second Address | Camp Pendleton, CA 92055-5191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 24/01/2018 |