Provider Demographics
NPI:1902024060
Name:S ROBERT HARLA DO PA
Entity Type:Organization
Organization Name:S ROBERT HARLA DO PA
Other - Org Name:S ROBERT HARLA DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT- OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:S
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HARLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-329-1873
Mailing Address - Street 1:2321 IRA E WOODS AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8632
Mailing Address - Country:US
Mailing Address - Phone:817-329-2263
Mailing Address - Fax:817-329-3793
Practice Address - Street 1:2321 IRA E WOODS AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8632
Practice Address - Country:US
Practice Address - Phone:817-329-2263
Practice Address - Fax:817-329-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2053207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0058QNOtherBCBS GROUP NUMBER
TX0025BCMedicare PIN