Provider Demographics
NPI:1073596870
Name:HARFORD, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HARFORD
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 1:750 E LATHAM AVE
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4370
Mailing Address - Country:US
Mailing Address - Phone:952-658-2271
Mailing Address - Fax:951-766-7653
Practice Address - Street 1:750 E LATHAM AVE
Practice Address - Street 2:SUITE # 3
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4370
Practice Address - Country:US
Practice Address - Phone:952-658-2271
Practice Address - Fax:951-766-7653
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86180207N00000X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI31957Medicare UPIN
CAY36439Medicare UPIN
CAZZZ01928ZMedicare ID - Type UnspecifiedGROUP ID
CA00G861800Medicare ID - Type UnspecifiedPPIN