Provider Demographics
NPI:1063482727
Name:HARMON, KEITH HANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:HANNA
Last Name:HARMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120069
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-0069
Mailing Address - Country:US
Mailing Address - Phone:817-274-1999
Mailing Address - Fax:817-274-4671
Practice Address - Street 1:950 N DAVIS DR
Practice Address - Street 2:SUITE 4
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3247
Practice Address - Country:US
Practice Address - Phone:817-460-0104
Practice Address - Fax:817-860-2184
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1623208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B23316Medicare UPIN