Provider Demographics
NPI:1205819349
Name:ROBERT HARFORD M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT HARFORD M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-658-2272
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:951-658-2272
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:951-658-2272
Practice Address - Fax:951-766-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86180207N00000X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073596870OtherROBERT HARFORD NPI
1073596870OtherROBERT HARFORD NPI
CAY36439Medicare UPIN
CA00G861800Medicare ID - Type UnspecifiedROBERT HARFORD PPIN
CAZZZ01928ZMedicare ID - Type UnspecifiedGROUP ID