Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0101840374 | VA |
NPI | 1003805359 |
---|---|
Provider Name | Philip S. Harry |
First Address | Fredericksburg, VA 22401-3377 |
Second Address | Fredericksburg, VA 22401-3377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 10/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6402135 | (05) | VA |
G94411 | (02) |