Provider Demographics
NPI:1598784142
Name:HARWAY, ROBERT ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLAN
Last Name:HARWAY
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 1:150 TEJAS PL
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9123
Mailing Address - Country:US
Mailing Address - Phone:805-929-3211
Mailing Address - Fax:805-929-6440
Practice Address - Street 1:1551 BISHOP ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4635
Practice Address - Country:US
Practice Address - Phone:805-269-1300
Practice Address - Fax:805-269-1384
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA18577207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124045158OtherCOMMHLTHCNTRS, SAN LUIS OBISPO NPI#
CAFHC71031FMedicaid
CA1841217866OtherCOMMHLTHCNTRS, NIPOMO
CA1275553257OtherCOMMHLTHCNTRS, SAN LUIS OBISPO
CAWA18577F - W1508DMedicare PIN
CAWA18577E - W1508CMedicare PIN
CAWA18577B - W1508Medicare PIN
CAWA18577G - W1508EMedicare PIN
CAWA18577D - W1508DMedicare PIN
CAWA18577H - W1508FMedicare PIN
CAA21375Medicare UPIN
CA1841217866OtherCOMMHLTHCNTRS, NIPOMO