Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 16141 | CO |
N | 207VG0400X | Gynecologist | 16141 | CO |
NPI | 1154397685 |
---|---|
Provider Name | Mr. Mallory T Harling |
First Address | Basalt, CO 81621-8352 |
Second Address | Basalt, CO 81621-8352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 06/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01161413 | (05) | CO |
1609842145 | GROUP NPI (01) | |
201467647 | TAX ID (01) | |
D22997 | (02) |