Provider Demographics
NPI:1275526956
Name:HARMON, LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
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 1:2044 MADISON AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4641
Mailing Address - Country:US
Mailing Address - Phone:618-451-1500
Mailing Address - Fax:
Practice Address - Street 1:2044 MADISON AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4641
Practice Address - Country:US
Practice Address - Phone:618-451-1500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45063Medicare UPIN
ILL90476Medicare ID - Type Unspecified