Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD00016022 | WA |
NPI | 1083607048 |
---|---|
Provider Name | Robert F Harris |
First Address | Bellingham, WA 98225-1892 |
Second Address | Bellingham, WA 98225-1892 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8104002 | (05) | WA |
A09527 | (02) | WA |