Provider Demographics
NPI:1710261227
Name:BIXBY, HARLAN KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:HARLAN
Middle Name:KEITH
Last Name:BIXBY
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 1:5 OAK KNOLL TER
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4534
Mailing Address - Country:US
Mailing Address - Phone:636-696-3722
Mailing Address - Fax:626-737-7449
Practice Address - Street 1:624 W DUARTE RD STE 207
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9265
Practice Address - Country:US
Practice Address - Phone:818-445-6976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19356207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology