Provider Demographics
NPI:1366460032
Name:HARMON, IRA (MD)
Entity Type:Individual
Prefix:
First Name:IRA
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 1:5685 NORWOOD AVE
Mailing Address - Street 2:SUITE 6017
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-5012
Mailing Address - Country:US
Mailing Address - Phone:904-354-0622
Mailing Address - Fax:904-354-0623
Practice Address - Street 1:580 W 8TH ST
Practice Address - Street 2:SUITE 6017
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6533
Practice Address - Country:US
Practice Address - Phone:904-354-0622
Practice Address - Fax:904-354-0623
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033826174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065485000Medicaid
FL065485000Medicaid
FLD52672Medicare UPIN