Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 27866 | MN |
NPI | 1003892860 |
---|---|
Provider Name | Keith Harmon |
First Address | St Louis Park, MN 55426-1728 |
Second Address | St Louis Park, MN 55426-4705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 04/10/2011 |