Provider Demographics
NPI:1669684643
Name:HARMON, ROBERT C (MD/PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:HARMON
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 N CASCADE AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6262
Mailing Address - Country:US
Mailing Address - Phone:719-636-1201
Mailing Address - Fax:719-955-0986
Practice Address - Street 1:2920 N CASCADE AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6262
Practice Address - Country:US
Practice Address - Phone:719-636-1201
Practice Address - Fax:719-636-1326
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23219207R00000X
VA0116017619207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAGC1100Medicare PIN