Provider Demographics
NPI:1821422528
Name:HARBOR PRIMARY CARE PA
Entity Type:Organization
Organization Name:HARBOR PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THET
Authorized Official - Middle Name:
Authorized Official - Last Name:TUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-519-9066
Mailing Address - Street 1:4229 DIAMOND SQ
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-1840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 36TH ST
Practice Address - Street 2:SUITE G, MEDICAL ARTS CENTER
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4898
Practice Address - Country:US
Practice Address - Phone:772-519-9066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty