Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A79199 | CA |
NPI | 1043391352 |
---|---|
Provider Name | Maury K Harwood |
First Address | Modesto, CA 95350-1159 |
Second Address | Morgan Hill, CA 95037-8108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 24/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A791990 | (05) | CA |
00A791990 | BLUE SHIELD (01) | CA |
608896700 | DEPT OF LABOR (01) | CA |
H40538 | (02) | CA |
P00323030 | RAIL ROAD MEDICARE (01) | CA |