Provider Demographics
NPI:1386838241
Name:HLAVAC, HARRY FRANK (DPM)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:FRANK
Last Name:HLAVAC
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:619 E BLITHEDALE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1468
Mailing Address - Country:US
Mailing Address - Phone:415-464-9577
Mailing Address - Fax:415-464-9577
Practice Address - Street 1:619 E BLITHEDALE AVE
Practice Address - Street 2:STE B
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1468
Practice Address - Country:US
Practice Address - Phone:415-464-9577
Practice Address - Fax:415-464-9577
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE-01278213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE-01278OtherSTATE LICENSE