Provider Demographics
NPI:1205856960
Name:HARBER, PHILLIP IRVING (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:IRVING
Last Name:HARBER
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 1:1511 E VIA SOLEDAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4844
Mailing Address - Country:US
Mailing Address - Phone:310-386-1297
Mailing Address - Fax:
Practice Address - Street 1:1295 N. MARTIN AVE
Practice Address - Street 2:4335 DRACH
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4844
Practice Address - Country:US
Practice Address - Phone:520-626-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46187207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G461870Medicaid
CAA92629Medicare UPIN
CAWG46187AMedicare PIN
CAWG46187BMedicare ID - Type UnspecifiedPPIN #